Medical treatment apparatus and control method of medical treatment device

ABSTRACT

A medical treatment device to treat body tissues for conjugation, includes at least a pair of holding members configured to hold the body tissues, an energy output portion provided in at least one of the holding members and connected to an energy source to form a joined portion by supplying energy to the body tissues held by the pair of holding members and joining the body tissues, and a conjugation coating portion to a region from a neighborhood of a joined portion to coat joined surfaces with a substance capable of preventing fluid from invading during or after the body tissues being joined by adding the energy to the body tissues.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a Continuation Application of PCT Application No.PCT/JP2010/050840, filed Jan. 22, 2010, which was published under PCTArticle 21(2) in Japanese.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a medical treatment device, a medicaltreatment system, and a medical treatment method to cure/treat bodytissues.

2. Description of the Related Art

It is generally known that body tissues can be joined by (1) bringingbody tissues to be joined into contact, (2) denaturing proteins oftarget tissues, and (3) removing fluid present between target tissues.This is bond using a so-called hydrogen bond, which is a linkage usingpolarity of a polar group of amino acids constituting proteins. Such adescription can be found in, for example, U.S. Pat. No. 6,626,901.

Note that denaturing proteins denotes inducing a conformational change,which is one of features of proteins, that is, dissociating the linkageof polar groups linked with certain regularity to form theconformational structure of proteins. It becomes possible to promote anew linkage with a polar group present in adjacent proteins by using thepolar group freed by dissociating the linkage of polar groups and so alinkage of proteins and accordingly, conjugation of body tissues can beinduced.

To induce the phenomenon, various forms of energy such as highfrequencies, heat, ultrasonic, and laser light are used by medicaltreatment devices. By using such forms of energy, the temperature ofjoining target tissues is raised to denature proteins and to removefluid (H₂O) present between target tissues simultaneously. Conjugationof tissues is thereby achieved. Energy devices currently used as bloodvessel sealing devices use this phenomenon.

An effect brought about by removing fluid (H₂O) will be described. It isgenerally known that a water molecule H₂O has a strong polarity. Due tothe strong polarity, the water molecule is known to be easily linked toa polar group having a polarity. The linkage is also established betweenwater molecules H₂O, thereby inducing a phenomenon specific to watermolecules H₂O. For example, while the heat of vaporization of helium is0.0845 kJ/mol, the heat of vaporization of the water molecule H₂O is ahigh value of 40.8 kJ/mol (9.74666 kcal/mol). It is a known fact thatsuch a high value is a result of the hydrogen bonding acting betweenwater molecules H₂O. As described above, the water molecule H₂O iseasily linked to a molecule having a polar group due to the strongpolarity. That is, the water molecule H₂O is also easily linked toproteins having a polar group. This fact makes conjugation of tissuesdifficult in the presence of water molecules H₂O.

The reason that current treatment devices require energy for conjugationof tissues is none other than removal of water molecules H₂O. Removingwater molecules H₂O present between tissues to be joined in conjugationof tissues can be said to be a condition for achieving stable and tightconjugation.

On the other hand, it is self-evident that a large quantity of fluid ispresent in a living body. In addition to fluid present in each tissue, alarge quantity of fluid is also present outside tissues or outsideorgans such as various digestive juices, lubricants, and physiologicalsaline given for treatment. Depending on the fluid, the linkage ofproteins is dissociated and the strength of conjugation between bodytissues is weakened over time when viewed macroscopically.

BRIEF SUMMARY OF THE INVENTION

A medical treatment device to treat body tissues for conjugationaccording to the present invention, includes at least a pair of holdingmembers configured to hold the body tissues, an energy output portionprovided in at least one of the holding members and connected to anenergy source to form a joined portion by supplying energy to the bodytissues held by the pair of holding members and joining the bodytissues, and a conjugation coating portion to a region from aneighborhood of a joined portion to coat joined surfaces with asubstance capable of preventing fluid from invading during or after thebody tissues being joined by adding the energy to the body tissues.

Advantages of the invention will be set forth in the description whichfollows, and in part will be obvious from the description, or may belearned by practice of the invention. Advantages of the invention may berealized and obtained by means of the instrumentalities and combinationsparticularly pointed out hereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 is a schematic diagram showing a medical treatment systemaccording to a first embodiment.

FIG. 2 is a schematic block diagram showing the medical treatment systemaccording to the first embodiment.

FIG. 3A is a schematic longitudinal sectional view showing a closedtreatment portion and a shaft of a bipolar type energy treatment deviceof the medical treatment system according to the first embodiment.

FIG. 3B is a schematic longitudinal sectional view showing the openedtreatment portion and the shaft of the energy treatment device of themedical treatment system according to the first embodiment.

FIG. 4A is a schematic plan view viewed from an arrow 4A direction inFIGS. 4B and 4C, and shows a first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 4B is a schematic longitudinal sectional view along a 4B-4B line inFIGS. 4A and 4C, and shows the first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 4C is a schematic transverse sectional view along a 4C-4C line inFIGS. 4A and 4B, and shows the first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 4D is a schematic perspective view showing a projection disposed ona high-frequency electrode of the first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 5A is a schematic plan view viewed from an arrow 5A direction inFIGS. 5B and 5C, and shows a second holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 5B is a schematic longitudinal sectional view along a 5B-5B line inFIGS. 5A and 5C, and shows the second holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 5C is a schematic transverse sectional view along a 5C-5C line inFIGS. 5A and 5B, and shows the second holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the first embodiment.

FIG. 6A is a schematic graph showing a relationship between the time andimpedance when body tissues are held by the treatment portion of theenergy treatment device of the medical treatment system according to thefirst embodiment and high-frequency energy is applied to the held bodytissues.

FIG. 6B is a schematic perspective view showing the state of bodytissues immediately after being treated by using the energy treatmentdevice of the medical treatment system according to the firstembodiment.

FIG. 7 is a flow chart showing a state of control of the medicaltreatment system exercised by an energy source, a foot switch, and afluid source when body tissues are joined and an outer circumference ofthe joined body tissue is coated by using the medical treatment systemaccording to the first embodiment.

FIG. 8 is a schematic graph showing the relationship between the timeand a phase difference when body tissues are held by the treatmentportion of the energy treatment device of the medical treatment systemand the high-frequency energy is applied to the held body tissuesaccording to a first modification of the first embodiment.

FIG. 9 is a schematic block diagram showing the medical treatment systemwhen a change of the phase difference is used as a threshold ofsupplying the high-frequency energy/stopping the supply of thehigh-frequency energy for treatment according to the first modificationof the first embodiment.

FIG. 10A is a schematic longitudinal sectional view showing the state inwhich a heater is disposed in the first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to a second modification of the first embodiment.

FIG. 10B is a schematic longitudinal sectional view showing the state inwhich a heater is disposed in the second holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the second modification of the first embodiment.

FIG. 11A is a schematic plan view viewed from an arrow 11A direction inFIGS. 11B and 11C, and shows the first holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to a third modification of the first embodiment.

FIG. 11B is a schematic longitudinal sectional view along a 11B-11B linein FIGS. 11A and 11C, and shows the first holding member of thetreatment portion of the energy treatment device of the medicaltreatment system according to the third modification of the firstembodiment.

FIG. 11C is a schematic transverse sectional view along a 11C-11C linein FIGS. 11A and 11B, and shows the first holding member of thetreatment portion of the energy treatment device of the medicaltreatment system according to the third modification of the firstembodiment.

FIG. 12 is a schematic diagram showing the state of body tissues beingtreated by using the monopolar type energy treatment device of themedical treatment system according to a fourth modification of the firstembodiment.

FIG. 13 is a schematic diagram showing the medical treatment systemaccording to a fifth modification of the first embodiment.

FIG. 14 is a schematic diagram showing a medical treatment systemaccording to a second embodiment.

FIG. 15 is a schematic block diagram showing the medical treatmentsystem according to the second embodiment.

FIG. 16A is a schematic longitudinal sectional view showing a closedtreatment portion and a shaft of a bipolar type energy treatment deviceof the medical treatment system according to the second embodiment.

FIG. 16B is a schematic longitudinal sectional view showing the opentreatment portion and the shaft of the energy treatment device of themedical treatment system according to the second embodiment.

FIG. 17A is a schematic plan view viewed from an arrow 17A direction inFIG. 17B, and shows a first holding member of the treatment portion ofthe energy treatment device of the medical treatment system according tothe second embodiment.

FIG. 17B is a schematic transverse sectional view along a 17B-17B linein FIG. 17A, and shows the first holding member of the treatment portionof the energy treatment device of the medical treatment system accordingto the second embodiment.

FIG. 18A is a schematic perspective view showing a tip portioncontaining a cutting portion of a cutter disposed on the energytreatment device of the medical treatment system according to the secondembodiment.

FIG. 18B is a schematic transverse sectional view showing the cutterdisposed on the energy treatment device of the medical treatment systemaccording to the second embodiment.

FIG. 18C is a schematic transverse sectional view showing the state oftreating and conjugating body tissues while being held by the treatmentportion of the energy treatment device of the medical treatment systemand cutting the body tissues by the cutter according to the secondembodiment.

FIG. 18D is a schematic perspective view showing the state of bodytissues immediately after being treated by using the energy treatmentdevice of the medical treatment system according to the secondembodiment.

FIG. 19 is a flow chart showing the state of control of the medicaltreatment system exercised by an energy source, a foot switch, and afluid source when body tissues are treated by using the medicaltreatment system according to the second embodiment.

FIG. 20A is a schematic perspective view showing a tip portioncontaining a cutting portion of a cutter disposed on an energy treatmentdevice of a medical treatment system according to a first modificationof the second embodiment.

FIG. 20B is a schematic transverse sectional view showing the cutterdisposed on the energy treatment device of the medical treatment systemaccording to the first modification of the second embodiment.

FIG. 21A is a rough plan view viewed from an arrow 21A direction inFIGS. 21B and 21C, and shows a first holding member of a treatmentportion of an energy treatment device of the medical treatment systemaccording to a second modification of the second embodiment.

FIG. 21B is a schematic longitudinal sectional view along a 21B-21B linein FIGS. 21A and 21C, and shows the first holding member of thetreatment portion of the energy treatment device of the medicaltreatment system according to the second modification of the secondembodiment.

FIG. 21C is a schematic transverse sectional view along a 21C-21C linein FIGS. 21A and 21B, and shows the first holding member of thetreatment portion of the energy treatment device of the medicaltreatment system according to the second modification of the secondembodiment.

FIG. 22A is a schematic plan view viewed from an arrow 22A direction inFIG. 22B, and shows a first holding member of the treatment portion ofthe energy treatment device of the medical treatment system according toa third modification of the second embodiment.

FIG. 22B is a schematic transverse sectional view along a 22B-22B linein FIG. 22A, and shows the first holding member of the treatment portionof the energy treatment device of the medical treatment system accordingto the third modification of the second embodiment.

FIG. 23A is a schematic diagram showing a medical treatment systemaccording to a third embodiment.

FIG. 23B is a rough partial longitudinal sectional view showing a handleof an energy treatment device of the medical treatment system accordingto the third embodiment.

FIG. 24 is a rough block diagram showing the medical treatment systemaccording to the third embodiment.

FIG. 25A is a schematic longitudinal sectional view showing a closedtreatment portion and a shaft of the bipolar type energy treatmentdevice of the medical treatment system according to the thirdembodiment.

FIG. 25B is a schematic longitudinal sectional view showing the openedtreatment portion and the shaft of the energy treatment device of themedical treatment system according to the third embodiment.

FIG. 26A is a rough plan view showing a first holding member of thetreatment portion of the energy treatment device of the medicaltreatment system according to the third embodiment.

FIG. 26B is a rough transverse sectional view along a 26B-26B line inFIG. 26A showing the state in which body tissues are held by thetreatment portion of the energy treatment device of the medicaltreatment system according to the third embodiment.

FIG. 27 is a rough partial longitudinal sectional view showing amodification of the handle of the energy treatment device of the medicaltreatment system according to a first modification of the thirdembodiment.

FIG. 28A is a rough perspective view showing the state in which acoating member is disposed on a main body of each of the first holdingmember and a second holding member of the treatment portion of theenergy treatment device of the medical treatment system according to asecond modification of the third embodiment.

FIG. 28B is a rough perspective view showing the coating member disposedon the main body of the first holding member and the second holdingmember of the treatment portion of the energy treatment device of themedical treatment system according to the second modification of thethird embodiment.

FIG. 29A is a rough perspective view showing a sheet-shaped coatingmember disposed on the main body of the first and second holding membersof the treatment portion of the energy treatment device of the medicaltreatment system according to the second modification of the thirdembodiment.

FIG. 29B is a rough perspective view showing a porous coating memberdisposed on the main body of the first and second holding members of thetreatment portion of the energy treatment device of the medicaltreatment system according to the second modification of the thirdembodiment.

FIG. 29C is a rough perspective view showing a mesh-shaped coatingmember disposed on the main body of the first and second holding membersof the treatment portion of the energy treatment device of the medicaltreatment system according to the second modification of the thirdembodiment.

FIG. 30 is a schematic diagram showing a medical treatment systemaccording to a fourth embodiment.

FIG. 31A is a rough front view showing the state in which a mainbody-side holding member and a detachable-side holding member of atreatment portion of a bipolar type energy treatment device of themedical treatment system are detached according to the fourthembodiment.

FIG. 31B is a rough longitudinal sectional view along a 31B-31B line inFIG. 31A, and shows the state in which the main body-side holding memberand the detachable-side holding member of the treatment portion of theenergy treatment device of the medical treatment system are detachedaccording to the fourth embodiment.

FIG. 32 is a rough plan view viewed from an arrow 32 direction in FIG.31B, and shows the main body-side holding member of the treatmentportion of the energy treatment device of the medical treatment systemaccording to the fourth embodiment.

FIG. 33A is a rough front view showing the state in which the mainbody-side holding member and the detachable-side holding member of thetreatment portion of the bipolar type energy treatment device of themedical treatment system are closed according to the fourth embodiment.

FIG. 33B is a rough longitudinal sectional view showing the state inwhich the main body-side holding member and the detachable-side holdingmember of the treatment portion of the bipolar type energy treatmentdevice of the medical treatment system are open according to the fourthembodiment.

FIG. 33C is a rough perspective view showing a projection disposed on ahigh-frequency electrode of the detachable-side holding member of theenergy treatment device of the medical treatment system according to thefourth embodiment.

FIG. 34 is a rough front view showing the state in which a mainbody-side holding member and a detachable-side holding member of thetreatment portion of the bipolar type energy treatment device of themedical treatment system are detached according to a first modificationof the fourth embodiment.

FIG. 35 is a rough longitudinal sectional view showing the state inwhich the main body-side holding member and the detachable-side holdingmember of the treatment portion of the bipolar type energy treatmentdevice of the medical treatment system are opened according to the firstmodification of the fourth embodiment.

DETAILED DESCRIPTION OF THE INVENTION

The best mode for carrying out the present invention will be describedbelow with reference to drawings.

[First Embodiment]

The first embodiment will be described with reference to FIGS. 1 to 11.

For example, a linear-type surgical treatment device 12 for treatmentthrough the abdominal wall is taken as an example of the energytreatment device (medical treatment device).

As shown in FIGS. 1 and 2, a medical treatment system 10 includes theenergy treatment device 12, an energy source (control section) 14, afoot switch (or a hand switch) 16, and a fluid source 18.

As shown in FIG. 1, the energy treatment device 12 includes a handle 22,a shaft 24, and a treatment portion (holding portion) 26 which is ableto be opened and closed. The handle 22 is connected to the energy source14 via a cable 28. As shown in FIG. 2, the foot switch 16 is connectedto the energy source 14.

The foot switch 16 includes a pedal (not shown). A series of operationssuch as ON/OFF of the supply of energy (high-frequency energy in thepresent embodiment) from the energy source 14 to the surgical treatmentdevice 12 and further, whether to make a fluid (conjugation adjunct)flow described later can be switched by the pedal of the foot switch 16being operated (pressed/released) by an operator. While the pedal ispressed, high-frequency energy is output based on an appropriately setstate (state in which the output quantity of energy, timing of energyoutput and the like are controlled). When pedal pressing is released,the output of high-frequency energy is forced to stop. In addition, afluid of a predetermined flow rate is made to flow while the pedal ispressed and the flow of the fluid stops when pedal pressing is released.

As shown in FIG. 1, the handle 22 is formed in a shape that makes iteasier for the operator to grip and is formed, for example, in asubstantially L shape. The shaft 24 is disposed at one end of the handle22. The cable 28 described above is extended from a proximal end of thehandle 22 which is coaxial with the shaft 24. Electrical connectionlines 28 a, 28 b of high-frequency electrodes 92, 94 described later areinserted into the cable 28.

On the other hand, the other end side of the handle 22 is a gripperextending in a direction away from an axial direction of the shaft 24and gripped by the operator. The handle 22 includes a treatment portionopening/closing knob 32 being arranged side by side. The treatmentportion opening/closing knob 32 is coupled to the proximal end of asheath 44 (see FIGS. 3A and 3B) described later of the shaft 24 in asubstantially center portion of the handle 22. If the treatment portionopening/closing knob 32 is moved closer to or away from the other end ofthe handle 22, the sheath 44 moves along the axial direction thereof.

As shown in FIGS. 3A and 3B, the shaft 24 includes a pipe 42 and thesheath 44 slidably disposed on the outer side of the pipe 42. The baseend of the pipe 42 is fixed to the handle 22 (see FIG. 1). The sheath 44is slidable along the axial direction of the pipe 42.

A recess 46 is formed on the outer side of the pipe 42 along the axialdirection thereof. An electrode connection line 28 a connected to thehigh-frequency electrode (energy output portion) 92 described later isdisposed in the recess 46. An electrode connection line 28 b connectedto the high-frequency electrode (energy output portion) 94 describedlater is inserted into the pipe 42.

As shown in FIG. 1, the treatment portion 26 is disposed at the tip ofthe shaft 24. As shown in FIGS. 3A and 3B, the treatment portion 26includes a pair of holding members 52, 54, that is, the first holdingmember (first jaw) 52 and the second holding member (second jaw) 54.

The first and second holding members 52, 54 shown in FIGS. 3A and 3Beach have suitably insulating properties as a whole. As shown in FIGS.4A to 4C, the first holding member 52 integrally includes a firstholding member main body (hereinafter, referred to mainly as a mainbody) 62 and a base 64 provided in the proximal end of the main body 62.The main body 62 is a portion which holds body tissues L1, L2 shown inFIG. 6B in collaboration with a main body 72 described later of thesecond holding member 54 and has a holding surface (edge) 62 a. The base64 is a portion coupled to the tip of the shaft 24. The main body 62 andthe base 64 of the first holding member 52 are disposed coaxially. Then,a step 66 is formed between the main body 62 and the base 64.

As shown in FIGS. 5A to 5C, the second holding member 54 integrallyincludes a second holding member body (hereinafter, referred to mainlyas a main body) 72 and a base 74 provided in the proximal end of themain body 72. The main body 72 is a portion that holds the body tissuesL1, L2 in collaboration with the main body 62 of the first holdingmember 52 and has a holding surface (edge) 72 a. The base 74 is aportion coupled to the tip of the shaft 24. The main body 72 and thebase 74 of the second holding member 54 are disposed coaxially. Then, astep 76 is formed between the main body 72 and the base 74.

In the present embodiment and embodiments described below, the main body62 of the first holding member 52 and the main body 72 of the secondholding member 54 have the same shape. Though the base 74 of the secondholding member 54 is different from the base 64 of the first holdingmember 52 in that the base 74 of the second holding member 54 is formed,as will be described later, so as to be pivotally supported by the pipe42 of the shaft 24, the base 64 of the first holding member 52 and thebase 74 of the second holding member 54 have the same structure in otherrespects and thus, the description thereof is omitted when appropriate.

As shown in FIGS. 4C and 5C, exterior surfaces of the main bodies 62 and72 of the first and second holding members 52 and 54 are formed as asmooth curved surface. Though not shown, the exterior surfaces of thebases 64 and 74 of the first and second holding members 52 and 54 arealso formed as a smooth curved surface. In a state in which the secondholding member 54 is closed with respect to the first holding member 52,the transverse section of the treatment portion 26 is formed in asubstantially circular shape or a substantially elliptic shape alongwith the transverse sections of the main bodies 62, 72 and the bases 64,74. In a state in which the second holding member 54 is closed withrespect to the first holding member 52, the holding surfaces (edges) 62a, 72 a of the main bodies 62, 72 of the first and second holdingmembers 52, 54 are mutually opposite to each other and in contact.Incidentally, in this state, the outside diameter of the base end of themain bodies 62, 72 of the first and second holding members 52, 54 isformed larger than the outside diameter of the bases 64, 74. Then, thesteps 66, 76 described above are formed between the main bodies 62, 72and the bases 64, 74, respectively.

As shown in FIGS. 3A and 3B, the first holding member 52 has the base 64thereof fixed to the tip portion of the pipe 42 of the shaft 24. On theother hand, the second holding member 54 has the base 74 thereofrotatably supported on the tip portion of the pipe 42 of the shaft 24 bya support pin 82 disposed in a direction perpendicular to the axialdirection of the shaft 24. The second holding member 54 can be opened22- and closed with respect to the first holding member 52 by beingrotated around the axis of the support pin 82. The second holding member54 is energized by, for example, an elastic member 84 such as a platespring so as to be opened with respect to the first holding member 52.

The first and second holding members 52, 54 are formed in a closed stateof the second holding member 54 with respect to the first holding member52 in such a way that an outer circumferential surface in asubstantially circular shape or a substantially elliptic shape togetherwith the bases 64, 74 thereof is substantially flush with the outercircumferential surface of the tip portion of the pipe 42 or slightlylarger. Thus, the sheath 44 can be slid with respect to the pipe 42 soas to cover the bases 64, 74 of the first and second holding members 52,54 with the tip of the sheath 44.

In this state, as shown in FIG. 3A, the second holding member 54 isclosed with respect to the first holding member 52 against an energizingforce of the elastic member 84. On the other hand, if the sheath 44 isslid to the proximal end side of the pipe 42 from the state in which thebases 64, 74 of the first and second holding members 52, 54 are coveredwith the tip of the sheath 44, as shown in FIG. 3B, the second holdingmember 54 is opened with respect to the first holding member 52 due toan energizing force of the elastic member 84.

As shown in FIGS. 4A to 4C, the main body 62 of the first holding member52 has channels 62 b formed in a concave shape in two rows that arepreferably in parallel respectively. That is, the channels 62 b of themain body 62 are open to the outside. The tip ends of the channels 62 bare closed.

The base 64 has ducts 64 a in two rows that are preferably in parallel.That is, the ducts 64 a of the base 64 are closed from the outsideexcluding both ends. The channels 62 b of the main body 62 and the ducts64 a of the base 64 are formed successively. The tip ends of a hose 18 ainserted into the shaft 24 and having flexibility is connected to theproximal end of the ducts 64 a of the base 64. The proximal end of thehose 18 a is extended to the outside of the energy treatment device 12through the handle 22 to be connected to the fluid source 18. Thus, afluid described later such as a liquid reserved in the fluid source 18can be led to the ducts 64 a of the base 64 of the first holding member52 and the channels 62 b of the main body 62 through the hose 18 a. Atransparent or translucent flexible tube is preferably used as the hose18 a outside the energy treatment device 12. By using such a transparentor translucent tube, the flow of a liquid can visually be recognized.

When a liquid is led from the fluid source 18 to the treatment portion26, the hose 18 a is preferably branched out into two or four inpositions close to the base 64 of the first holding member 52.

When a liquid is supplied to the first holding member 52 through thehose 18 a, depending on the viscosity of the liquid led from the fluidsource 18 to the treatment portion 26, the supply may be assisted byusing pneumatic pressure or the like.

The plate-like high-frequency electrodes (joining members) 92, 94 aredisposed as an output member and an energy discharge portion inside theholding surfaces (edges) 62 a, 72 a of the main bodies 62, 72 of thefirst and second holding members 52, 54. These high-frequency electrodes92, 94 are electrically connected to the tip of the electricalconnection lines 28 a, 28 b via connectors 96 a, 96 b. Then, theseelectrical connection lines 28 a, 28 b are connected to a high-frequencyenergy output portion 104 described later of the energy source 14. Thus,the body tissues L1, L2 are heated and denatured by passing powerthrough the body tissues L1, L2 held between the high-frequencyelectrodes 92, 94 to generate Joule heat in the body tissues L1, L2.

The high-frequency electrode 92 is to cap the channels 62 b in a grooveshape each in two rows of the main body 62 and form each of the channels62 b as a duct. A plurality of projections (a join condition sustainmentassistance portion) 202 is formed toward a second holding member 54 in aportion of the first high-frequency electrode 92 on the recess 62 b ofthe main body 62 of the first holding member 52. The projection 202 isformed to a suitable length so as to form a hole P shown in FIG. 6B inbody tissues L1, L2. The projection 202 does not necessarily need topass through the body tissues L1, L2 and the tip end (far end withrespect to the first high-frequency electrode 92) of the projection 202is suitably positioned closer to a second high-frequency electrode 94than contact surfaces C1, C2 of the body tissues L1, L2.

As shown in FIG. 4D, each of the projections 202 has one or a pluralityof openings 204 formed therein. Each of the projections 202 preferablyhas a plurality of openings 204 formed therein. The projection 202 iscommunicatively connected to the recess 62 b and can ooze out a fluid(conjugation adjunct) such as an adhesive through the recess 62 b. Theprojections 202 are preferably disposed, for example, at equal intervalsor in such a way that the same amount of liquid is oozed out from theopening 204 of each of the projections 202 by adjusting, for example,the diameter of the opening 204.

As shown in FIGS. 5A to 5C, recesses (conjugation sustainment assistanceportions) 206 are formed in the high-frequency electrode 94. Each of therecesses 206 is formed so as to accept the projection 202 projectingfrom the high-frequency electrode 92 disposed in the first holdingmember 52.

As shown in FIGS. 4B, 4C, 5B, and 5C, the surface of the high-frequencyelectrodes 92, 94 is positioned lower than the edges 62 a, 72 a of themain bodies 62, 72 of the first and second holding members 52, 54 andthe length of the projection 202 of the first high-frequency electrode92 is formed to such a height that the projection 202 does not come intocontact with the recess 206 of the second holding member 54. That is,even when the projection 202 of the first high-frequency electrode 92 isdisposed in the recess 206 of the second high-frequency electrode 94,the first high-frequency electrode 92 and the second high-frequencyelectrode 94 are formed so as not to come into contact with each other.

In addition to using for treatment of body tissues L1, L2 byhigh-frequency energy, the high-frequency electrodes 92, 94 can be usedas sensors to measure an impedance Z (see FIG. 6A) or a phase 8 (seeFIG. 8A) between the body tissues L1, L2. The high-frequency electrodes92, 94 can transmit/receive a signal to/from a detector 106 describedlater of an energy source 14 through, for example, the electricalconnection lines 28 a, 28 b. It is assumed here that the impedance Z ismeasured by the detector 106.

As shown in FIG. 2, the energy source 14 includes a first controller(energy control unit) 102, the high-frequency energy output portion(first high-frequency energy output unit) 104, the detector 106, adisplay unit 108, and a speaker 110. The high-frequency energy outputportion 104, the detector 106, the display unit 108, and the speaker 110are connected to the first controller 102 so that the high-frequencyenergy output portion 104, the detector 106, the display unit 108, andthe speaker 110 are controlled by the first controller 102.

The high-frequency energy output portion 104 generates energy andsupplies the energy to the high-frequency electrodes 92, 94 via theelectrical connection lines 28 a, 28 b. Incidentally, the high-frequencyenergy output portion 104 also functions as an energy output portionthat supplies energy to heaters 222, 232 (see FIGS. 10A and 10B) thatwill be described in a second modification.

The detector 106 detects measurement results obtained by thehigh-frequency electrodes 92, 94 holding the body tissues L1, L2 throughthe electrical connection lines 28 a, 28 b to calculate the impedance Z.The display unit 108 is a unit in which various settings are made suchas the setting of a threshold Z1 of the impedance Z while a setting ischecked through the display. The speaker 110 has a sound source (notshown) and produces a sound when a treatment is finished or a problemarises. The sound used to tell the end of treatment and the sound usedto tell an occurrence of problem have different tones. The speaker 110can also produce a distinct sound during treatments, for example, asound to tell the end of the first step of the treatment and a sound totell the end of the second step of the treatment.

The foot switch 16 is connected to the first controller 102 of theenergy source 14 and also a second controller (flow rate control unit)132 described later of the fluid source 18 is connected thereto. Thus,if the foot switch 16 is operated, the energy source 14 works and alsothe fluid source 18 works.

If the foot switch 16 is changed to ON (a pedal not shown is pressed), atreatment by the energy treatment device 12 is carried out and if thefoot switch 16 is changed to OFF (the pedal is released), the treatmentstops. The display unit 108 functions as a setting unit (controller)when an output quantity (the output quantity itself or what kind oftreatment to adopt (treatment for the purpose of joining the bodytissues L1, L2, treatment for the purpose of sealing openings of thebody tissues or the like)) of the high-frequency energy output portion104 or output timing of energy is controlled by the first controller102. It is needless to say that the display unit 108 has a displayfunction to display what is set.

The detector 106 can detect (calculate) the impedance Z of the bodytissues L1, L2 between the first and second high-frequency electrodes92, 94 through the first and second high-frequency electrodes 92, 94that output high-frequency energy. That is, the detector 106 and thefirst and second high-frequency electrodes 92, 94 have a sensor functionto measure the impedance Z of the body tissues L1, L2 between the firstand second high-frequency electrodes 92, 94.

The fluid source 18 includes a fluid reservoir 122 and a flow rateadjuster 124. The flow rate adjuster 124 includes a second controller(flow rate control unit) 132 and a flow rate adjustment mechanism 134.

The fluid reservoir 122 shown in FIG. 1 is formed from, for example, atransparent bag to store a fluid. The proximal end of the hose 18 a isremovably connected to the fluid reservoir 122. The second controller132 of the flow rate adjuster 124 is connected to the first controller102 of the energy source 14. Therefore, the second controller 132 worksby being linked to the energy source 14. The flow rate adjustmentmechanism 134 is formed from, for example, a pinch cock so as to adjustthe flow rate of a fluid flowing into the energy treatment device 12through the hose 18 a. That is, the second controller 132 controls theflow rate of a fluid such as a liquid supplied from the fluid reservoir122 to the first and second holding members 52, 54 via the hose 18 a byoperating the flow rate adjustment mechanism 134.

A substance (conjugation adjunct), for example, an adhesive to preventfluid from invading a body tissue L_(T) when applied to an exteriorsurface Sc of the body tissue L_(T) treated by high-frequency energy canbe stored in the fluid reservoir 122. The substance to prevent fluidfrom invading the body tissue L_(T) is preferably a bioabsorbablesubstance which invades body tissues when applied to the body tissues.The substance to be stored in the fluid reservoir 122 may be, inaddition to liquids, for example, gel substances. That is, the substancestored in the fluid reservoir 122 may be any fluid that can be passedthrough the hose 18 a. The substance which prevents fluid frompenetrating the body tissue L_(T) contains a compound. The compound is asubstance that coats or joins the body tissue L_(T) by a physicalaction, a chemical action, or both actions. The compound preferablycontains at least one of protein, glucide, polymer, and hardener. Theprotein suitably contains at least one of fibrin, albumin, collagen, andgelatin. The glucide suitably contains at least one of starch,hyaluronic acid, and chitosan. The polymer is suitably polyethyleneglycol, polyglycolic acid, polylactic acid, or polycaprolactam. Thehardener is suitably an acrylate derivative, aldehyde derivative,succinimide derivative, or isocyanate derivative. That is, for example,an organic adhesive, inorganic adhesive, bonding biomaterial,crosslinking agent, and monomer/polymer resins can be cited as asubstance (joining adjunct) to prevent fluid from penetrating bodytissues. When an adhesive is used, various types thereof such as atwo-component type can be used.

Further, for example, a liquid or gel substance of adhesive stored inthe fluid reservoir 122 may contain an antibiotic, growth promoter andthe like.

Table 1 shows main components of eight auxiliary joining members usedfor experiments to join the body tissues L1, L2 described below andcorresponding types of the auxiliary joining members. It is needless tosay that main components and types of the auxiliary joining members arenot limited to the main components and types shown in Table 1.

TABLE 1 Main components and types of the auxiliary joining members usedfor experiments to join body tissues No. Main component Type (1)Cyanoacrylate monomer Cyanoacrylate adhesive (2) Fibrinogen Fibrinadhesive Thrombin (3) Glutaraldehyde (crosslinking agent) Aldehydeadhesive Albumin (main agent) (4) Formaldehyde (crosslinking agent)Glutaraldehyde (crosslinking agent) Gelatin (main agent) (5) Organicsuccinimide (crosslinking Succinimide adhesive agent) Albumin (mainagent) (6) PEG succinimide (crosslinking agent) Albumin (main agent) (7)Polyglycolic acid Biodegrative polymer (8) Polycaprolactam Biodegrativepolymer

If a liquid substance is stored in the fluid reservoir 122, the liquidsubstance can be led to the ducts 64 a, 74 a of the bases 64, 74 and thechannels 62 b, 72 b of the main bodies 62, 72 of the first and secondholding members 52, 54 of the energy treatment device 12 through thehose 18 a connected to the fluid reservoir 122. If a gel substance isstored in the fluid reservoir 122, the gel substance can be led to theduct 64 a of the base 64 and the channel 62 b of the main body 62 of thefirst holding member 52 of the energy treatment device 12 through thehose 18 a connected to the fluid reservoir 122 by applying, for example,pneumatic pressure or the like to the fluid reservoir 122.

FIG. 6A shows a relationship between an energy supply time t of the bodytissues L1, L2 between the high-frequency electrodes 92, 94 and theimpedance Z between the body tissues L1, L2 when desired energy issupplied from the high-frequency energy output portion 104 to thehigh-frequency electrodes 92, 94 and high-frequency treatment of thebody tissues L1, L2 is carried out. FIG. 7 shows an example of thecontrol flow of the surgical treatment device 12 by the high-frequencyenergy output portion 104.

Next, the action of the medical treatment system 10 according to thepresent embodiment will be described.

A fluid with which the outer circumference of the body tissue L_(T)obtained by joining the two body tissues L1, L2 is coated after the bodytissues L1, L2 are joined by treatment with high-frequency energy is putinto the fluid reservoir 122 of the fluid source 18. It is assumed herethat the fluid is an adhesive for the body tissue L_(T). Particularly,the adhesive suitably has a quick-drying capability with which, forexample, the adhesive dries quickly after being exposed to the air. Thehose 18 a connected to the fluid reservoir 122 is closed by the flowrate adjustment mechanism 134 so that the adhesive does not normallyflow from the fluid reservoir 122 toward the energy treatment device 12.

The operator operates the display unit 108 of the energy source 14 inadvance to set output conditions for the medical treatment system 10(step S11). The operator checks the output (set power Pset [W]) from thehigh-frequency energy output portion 104, the threshold Z1 [Ω] of theimpedance Z by the detector 106, a maximum energy supply time t1 [sec]and the like through the display unit 108. If the output from thehigh-frequency energy output portion 104 or the threshold Z1 of theimpedance Z by the detector 106 should be set to a different value, theoperator sets the value as desired and checks the value through thedisplay unit 108. The operator also sets a flow rate V1 to be passedfrom the fluid reservoir 122 to the energy treatment device 12 throughthe hose 18 a. Further, the operator sets a longest time t-max in whichthe hose 18 a is opened. That is, even if the flow rate V1 is notreached after the hose 18 a is opened, the hose 18 a is automaticallyclosed after the time t-max passes.

As shown in FIG. 3A, the treatment portion 26 and the shaft 24 of thesurgical treatment device 12 are inserted into the abdominal cavitythrough, for example, the abdominal wall in the state in which thesecond holding member 54 is closed to the first holding member 52. Thetreatment portion 26 of the surgical treatment device 12 is opposed tothe body tissues L1, L2 to be treated (to be held).

The operator operates the treatment portion opening/closing knob 32 ofthe handle 22 to hold the body tissues L1, L2 to be treated by the firstholding member 52 and the second holding member 54. With this operation,the sheath 44 is moved to the side of the proximal end of the shaft 24with respect to the pipe 42. The space between the bases 64, 74 can nolonger be sustained in a cylindrical shape due to the energizing forceof the elastic member 84 and the second holding member 54 is opened withrespect to the first holding member 52 (see FIG. 3A).

The body tissues L1, L2 to be joined (to be treated) are arrangedbetween the high-frequency electrodes 92, 94 of the first and secondholding members 52, 54. The treatment portion opening/closing knob 32 ofthe handle 22 is operated in this state. In this case, the sheath 44 ismoved to the distal side of the shaft 24 with respect to the pipe 42.The space between the bases 64, 74 is closed by the sheath 44 againstthe energizing force of the elastic member 84 and to make it into acylindrical shape. Thus, the main body 62 of the first holding member 52formed integrally with the base 64 and the main body 72 of the secondholding member 54 formed integrally with the base 74 are closed. Thatis, the second holding member 54 is closed with respect to the firstholding member 52. In this manner, the body tissues L1, L2 to be joinedare held between the first holding member 52 and the second holdingmember 54.

In this case, the body tissue L1 to be treated is in contact with thehigh-frequency electrode 92 of the first holding member 52 and the bodytissue L2 to be treated is in contact with the high-frequency electrode94 of the second holding member 54. Peripheral tissues of the bodytissues L1, L2 to be joined are closely in contact with both oppositecontact surfaces of the holding surface (edge) 62 a of the main body 62of the first holding member 52 and the holding surface (edge) 72 b ofthe main body 72 of the second holding member 54. Incidentally, acontact surface C1 of the body tissue L1 and a contact surface C2 of thebody tissue L2 are in contact in such a way that pressure is applied toeach other.

At this point, because the projection 202 is disposed in thehigh-frequency electrode 92 disposed in the first holding member 52, theprojection 202 forms a hole P by penetrating through the body tissuesL1, L2 and also is received by the recess 206 disposed in thehigh-frequency electrode 94 (and the main body 72 of the second holdingmember 54).

Thus, the operator operates the pedal of the foot switch 16 while thebody tissues L1, L2 are held between the first holding member 52 and thesecond holding member 54. A signal is input into the first controller102 from the foot switch 16 and the first controller 102 of the energysource 14 determines whether the switch 16 is changed to ON by pressingthe pedal thereof through the operation of the operator (S12).

If the first controller 102 determines that the switch 16 is changed toON by pressing the pedal thereof, a signal is input into thehigh-frequency energy output portion 104 from the first controller 102.The high-frequency energy output portion 104 generates energy andsupplies the energy to the body tissues L1, L2 between thehigh-frequency electrodes 92, 94 through the electrical connection lines28 a, 28 b (S13). At this point, the high-frequency energy outputportion 104 supplies the set power Pset [W] set in advance through thedisplay unit 108, for example, power of about 20 [W] to 80 [W] tobetween the high-frequency electrode 92 of the first holding member 52and the high-frequency electrode 94 of the second holding member 54.

Thus, the high-frequency energy output portion 104 passes ahigh-frequency current to the body tissues L1, L2 to be joined betweenthe high-frequency electrode 92 of the first holding member 52 and thehigh-frequency electrode 94 of the second holding member 54. That is,the high-frequency energy output portion 104 applies high-frequencyenergy to the body tissues L1, L2 held between the high-frequencyelectrodes 92, 94. Thus, the body tissues L1, L2 are heated bygenerating Joule heat in the body tissues L1, L2 held between thehigh-frequency electrodes 92, 94. Cell membranes inside the body tissuesL1, L2 held between the high-frequency electrodes 92, 94 are destroyedby the action of Joule heat to release substances inside the cellmembrane so that the substances are equalized with components outsidethe cell membrane including collagen. Since a high-frequency current isbeing passed to the body tissues L1, L2 between the high-frequencyelectrodes 92, 94, further Joule heat is acted on the equalized bodytissues L1, L2 to conjugate, for example, the contact surfaces C1, C2 ofthe body tissues L1, L2 or layers of tissues. Therefore, if ahigh-frequency current is passed to the body tissues L1, L2 between thehigh-frequency electrodes 92, 94, the body tissues L1, L2 are heated andso the inside of the body tissues L1, L2 is denatured (the body tissuesL1, L2 are burned) while the body tissues L1, L2 are dehydrated,generating a joined portion C after the contact surfaces C1, C2 arebrought into close contact. In this manner, the two body tissues L1, L2are joined to form the body tissue L_(T) having the joined portion C.

At this point, the projection 202 provided in the high-frequencyelectrode 92 disposed in the first holding member 52 sustains a state inwhich the body tissues L1, L2 are penetrated through (state in which theprojection 202 is disposed in the hole P). Moreover, because theprojection 202 is disposed inside the body tissues L1, L2 and a currentis passed through body tissues between the projection 202 and the secondhigh-frequency electrode 94, the body tissues L1, L2 can efficiently betreated by using high-frequency energy.

With an increasing level of denaturation of the body tissues L1, L2, afluid (for example, a liquid (blood) and/or a gas (vapor)) is releasedfrom the body tissues L1, L2. In this case, the holding surfaces 62 a,72 a of the main bodies 62, 72 of the first and second holding members52, 54 have higher adhesiveness to the body tissues L1, L2 than thehigh-frequency electrodes 92, 94. Thus, the holding surfaces 62 a, 72 afunction as a barrier portion (dam) that inhibits a fluid from the bodytissues L1, L2 from escaping to the outside of the first holding member52 and the second holding member 54. That is, a thermal spread can beprevented from being generated in body tissues other than the bodytissues L1, L2 to be treated and joined.

In this case, the high-frequency electrodes 92, 94 of the first andsecond holding members 52, 54 have a sensor function and thus transmitinformation (impedance Z) about between the held body tissues L1, L2 tothe detector 106 through the electrical connection lines 28 a, 28 b. Asshown in FIG. 6A, an initial value Z0 of the impedance Z when treatmentis started (when the supply of high-frequency energy to between the bodytissues L1, L2 is started) is, for example, about 50[Ω] to 60[Ω]. As thebody tissues L1, L2 are increasingly burned by the high-frequencycurrent flowing into the body tissues L1, L2, the impedance Z drops toZmin (for example, about 10[Ω]) and then gradually rises.

The first controller 102 controls the detector 106 so that informationabout the body tissues L1, L2 between the high-frequency electrodes 92,94 is calculated at equal time intervals (for example, a fewmilliseconds). The first controller 102 determines whether the impedanceZ during high-frequency energy output operated based on a signal fromthe detector 106 is equal to or more than the threshold Z1 (here, asshown in FIG. 6A, about 1000 [Ω]) set (S11) in advance through thedisplay unit 108 (S14). It is, needless to say, that the threshold Z1 ofthe impedance Z can appropriately be set.

For example, the threshold Z1 is preferably larger than the initialvalue Z0 and in a position (see FIG. 6A) where the rate of rise of thevalue of the impedance Z slows down. If the first controller 102determines that the impedance Z has reached the threshold Z1 or exceededthe threshold Z1, a signal is conveyed from the first controller 102 tothe high-frequency energy output portion 104. Then, the output from thehigh-frequency energy output portion 104 to the high-frequencyelectrodes 92, 94 of the first and second holding members 52, 54 isstopped (S151).

On the other hand, if the impedance Z has not reached the threshold Z1,the output of energy is continued. If the first controller 102determines that the impedance Z between the body tissues L1, L2 issmaller than the threshold Z1, high-frequency energy for treatment willcontinue to be given to the body tissues L1, L2 held between thehigh-frequency electrodes 92, 94 of the first and second holding members52, 54. Then, if the impedance Z between the body tissues L1, L2 reachesthe threshold Z1 or a predetermined time t passes after the start ofenergy supply from the high-frequency energy output portion 104, thehigh-frequency energy output portion 104 is caused to stop the output ofenergy. At this point, the body tissue L_(T) is joined by the joinedportion C.

Then, the pedal of the foot switch 16 continues to be pressed. The bodytissue L_(T) sustains a state in which the body tissue L_(T) is held bythe holding members 52, 54.

The supply of energy from the high-frequency energy output portion 104to the high-frequency electrodes 92, 94 is stopped by the firstcontroller 102 (S151) and at the same time, a signal is conveyed fromthe first controller 102 to the second controller 132. The secondcontroller 132 causes the flow rate adjustment mechanism 134 to operateto open the hose 18 a (S152). Thus, an adhesive is supplied from thefluid reservoir 122 to the energy treatment device 12 through the hose18 a.

The duct 64 a is provided in the base 64 of the first holding member 52and the recess 62 b is provided in the main body 62 and thus, anadhesive is oozed out from the opening 204 of the projection 202. Inthis case, the projection 202 is disposed in the hole P by penetratingthrough the joined body tissue L_(T) and thus, a portion of the adhesiveoozed out from the opening 204 is applied to the joined portion C of thebody tissues L_(T). A portion of the adhesive invades and spreadsdirectly from joined surfaces of the joined portion C. The adhesive has,in addition to adhesive action, coating action. If exposed to, forexample, the air, the adhesive is gradually cured over time. Theadhesive here preferably has a fast-drying capability and has fluidresistance when cured.

Therefore, invasion of fluid into the joined portion C of the bodytissues L_(T) joined by the adhesive being cured can be prevented andalso a joined state can be maintained.

Adhesives have naturally different properties depending on the type ofadhesive and the reason why the adhesive in the present embodiment isapplied after the body tissues L1, L2 are joined is that an adhesive forbody tissues can display an effective adhesive action when applied in asdry a state of the body tissues L1, L2 as possible. That is, if anadhesive is applied in a state in which a sufficient amount of fluid isnot removed, it becomes more difficult to remove fluid from the bodytissues L1, L2 even if energy is provided, but such a state can beprevented by applying the adhesive after the body tissues L1, L2 arejoined. In addition, if an adhesive is applied in a state in which asufficient amount of fluid is not removed, the adhesive may be mixedwith fluid, but such a state can be prevented by applying the adhesiveafter the body tissues L1, L2 are joined.

When the adhesive of a predetermined flow rate is passed from the fluidreservoir 122 through the hose 18 a (S16) or after the hose 18 a isopened for a predetermined time, the second controller 132 causes theflow rate adjustment mechanism 134 to operate again to close the hose 18a (S17).

When a predetermined time (for example, a few seconds) passes after thehose 18 a is closed, a sound such as a buzzer from the speaker 110 isemitted to tell the completion of treatment (conjugation treatment ofbody tissues and treatment to prevent fluid from infiltrating into thejoined contact surfaces C1, C2) (S18). Then, after making sure that thetreatment has completed with the sound from the speaker 110 or thedisplay of the display unit 108, a medical doctor or the like releasesthe pedal by removing his or her foot from the pedal of the foot switch16.

The treatment continues from “Start” to “End” shown in FIG. 7 while thepedal of the foot switch 16 is kept pressed, but if the pedal isreleased at some point between “Start” and “End”, the first controller102 forces the treatment to stop when pressing of the pedal is released.That is, if the supply of high-frequency energy should be stopped inmidstream or the supply of adhesive should be stopped in midstream,pressing of the pedal of the foot switch 16 is released by removing afoot from the pedal before a sound such as a buzzer is emitted from thespeaker 110. When pressing of the pedal is released, the firstcontroller 102 forces to stop the output of energy from thehigh-frequency energy output portion 104 to electrodes 92, 94 if theenergy is output from the high-frequency energy output portion 104. Whenthe hose 18 a is opened, the second controller 132 forces to stop supplyof a fluid by causing the flow rate adjustment mechanism 134 to operateto close the hose 18 a.

After checking the buzzer sound from the speaker 110, the medical doctoroperates the treatment portion opening/closing knob 32 to release thebody tissue L_(T). In this case, as shown in FIG. 6B, the contactsurfaces C1, C2 of body tissues are joined to form the joined portion C.Moreover, the adhesive having bioabsorbability is hardened whileinvading from the exterior surface Sc to the joined portion C in thebody tissue L_(T) and thus, the body tissue L_(T) is in a state of beingcoated with the adhesive. Because the adhesive has bioabsorbability, theadhesive oozed out from the openings 92 a, 94 a may also be applied tothe side face of the body tissues L1, L2 shown in FIG. 6B.

An adhesive may be directly supplied into body tissues by an injectorsuch as a syringe instead of using the fluid reservoir 122. As a supplymethod of adhesive, the flow rate adjuster 124 may control the flow rateof adhesive into body tissues by using a rotary pump or the like.

According to the present embodiment, as described above, the followingeffect is achieved.

Close contact of the contact surfaces C1, C2 of the body tissues L1, L2can be made more reliable by treating and joining the body tissues L1,L2 while the impedance Z of the body tissues L1, L2 is measured. Afterthe body tissues L1, L2 are treated for conjugation, fluid can beprevented from seeping through into the joined portion C of the bodytissue L_(T) treated for conjugation by coating the outer circumferenceof the body tissue L_(T) treated for conjugation with an adhesive or thelike. Therefore, a state in which the contact surfaces C1, C2 of thebody tissues L1, L2 can closely be in contact (state in which the bodytissue L_(T) is joined) for a long time.

Joule heat can be generated not only in the body tissues L1, L2 betweenthe high-frequency electrodes 92, 94, but also in the body tissues L1,L2 between the projections 202 passing through the body tissues L1, L2and the high-frequency electrode 94. Thus, it can be made easier forenergy to penetrate the body tissues L1, L2 even if the body tissues L1,L2 are thick (if it is difficult for high-frequency energy to penetratethe body tissues L1, L2). Therefore, not only body tissues of thethickness that has been treatable by high-frequency energy, but alsostill thicker body tissues can reliably be treated by high-frequencyenergy.

A fluid such as an adhesive can directly be supplied into the joinedbody tissue L_(T) such as joined surfaces of the joined portion C of thebody tissues L1, L2 to be joined through the opening 204 of theprojection 202 provided in the high-frequency electrode 92 for invasion.Therefore, conjugation of the joined portion C can be made more reliableand also coating action of the adhesive can be exerted on theneighborhood of the joined portion C including joined surfaces.

In the present embodiment, a case when the hole P is formed in the bodytissues L1, L2 by the projection 202 of the first holding member 52 whenbody tissues are held by the first and second holding members 52, 54 isdescribed. In addition, the hole P does not necessarily need to beformed by the projection 202 when the body tissues L1, L2 are held bythe first and second holding members 52, 54. That is, when the bodytissues L1, L2 are held by the first and second holding members 52, 54,the body tissue L2 may be pressed against the recess 206 of the secondholding member 54 by the projection 202 of the first holding member 52.Even in this case, the hole P is formed in the body tissues L1, L2, thatis, the hole P is disposed in the projection 202 as high-frequencyenergy is supplied to the body tissues L1, L2 between the first andsecond high-frequency electrodes 92, 94.

The projections 202 of the high-frequency electrode 92 of the firstholding member 52 may be formed as a different body such as a hardeningresin material having insulating properties. In this case, theprojections 202 are permitted to come into contact with thehigh-frequency electrode 94 of the second holding member 54.

If a two-component adhesive is used as a fluid substance to coat theouter circumference of the joined body tissue L_(T) after the bodytissues L1, L2 are joined, two types of liquids may be provided side byside in the fluid source 18. In this case, the two hoses 18 a areextended from the fluid source 18 to the energy treatment device 12 sideby side to supply liquids to the channels 62 b, 72 b of the main bodies62, 72 of the first and second holding members 52, 54 through the handle22 and the shaft 24 independently. Then, two liquids are made to bemixed when oozed out from the openings 92 a, 94 a of the high-frequencyelectrodes 92, 94. In this manner, the adhesive can be prevented frombeing hardened inside the hose 18 a or the first and second holdingmembers 52, 54. When a two-component adhesive is used, it is alsopreferable to form two channels (not shown) in a hose 18 a.

While an example in which the impedance Z (see FIG. 6A) is used asliving body information detected by the detector 106 is described in theabove embodiment, it is also preferable to use the amount of change ofthe phase (phase difference Δθ) (see FIG. 8) as living body information.A case when the phase difference Δθ is used as a first modification ofthe first embodiment will be described below with reference to FIGS. 8and 9.

As shown in FIG. 9, the detector 106 includes a voltage detector 142, acurrent detector 144, and a phase detector 146. The phase detector 146is connected to the first controller 102. The voltage detector 142 andthe current detector 144 are connected to the energy treatment device 12(high-frequency electrodes 92, 94) and also connected to the phasedetector 146. This is not limited to the first embodiment and similarlyapplies to other embodiments described later.

If the high-frequency energy output portion 104 is caused to generate ahigh-frequency voltage, a high-frequency current having a predeterminedfrequency and peak value based on the high-frequency voltage of thehigh-frequency energy output portion 104 is output to the surgicaltreatment device 12 via the current detector 144. The voltage detector142 detects the peak value of the high-frequency voltage through thehigh-frequency energy output portion 104 and outputs the detected peakvalue to the phase detector 146 as output voltage value information. Thecurrent detector 144 detects the peak value of the high-frequencycurrent generated based on the high-frequency voltage through thehigh-frequency energy output portion 104 and outputs the detected peakvalue to the phase detector 146 as output current value information.

After detecting the phase of the high-frequency voltage output throughthe high-frequency energy output portion 104 based on output voltagevalue information output from the voltage detector 142, the phasedetector 146 outputs the detected phase to the first controller 102 asoutput voltage phase information along with output voltage valueinformation. Also after detecting the phase of the high-frequencycurrent through the high-frequency energy output portion 104 based onoutput current value information output from the current detector 144,the phase detector 146 outputs the detected phase to the firstcontroller 102 as output current phase information along with outputcurrent value information.

Based on output voltage value information, output voltage phaseinformation, output current value information, and output current phaseinformation output from the phase detector 146, the first controller 102calculates the phase difference Δθ of the high-frequency voltage andhigh-frequency current output through the high-frequency energy outputportion 104.

The first controller 102 controls the high-frequency energy outputportion 104 to change the output state of the high-frequency current andhigh-frequency voltage to the ON state or OFF state based on aninstruction signal output in accordance with an operation of the pedalof the foot switch 16 and the calculated phase difference Δθ.

As shown in FIG. 8, the phase difference Δθ of the high-frequencycurrent or high-frequency voltage output through the high-frequencyenergy output portion 104 is 0° or substantially 0° in the initial stageof treatment on the body tissue L_(T). Incidentally, the value of thephase difference Δθ is set to 900 or a value close thereto through thedisplay unit 108.

As the pedal of the foot switch 16 is pressed uninterruptedly andtreatment of the body tissues L1, L2 held between the high-frequencyelectrodes 92, 94 of the first and second holding members 52, 54proceeds, the body tissues L1, L2 are dehydrated followed by beingcauterized or coagulated. If the treatment proceeds in this manner, thephase difference Δθ of the high-frequency current or high-frequencyvoltage output through the high-frequency energy output portion 104increases from the state of 0° or substantially 0°, for example, after asuitable time t1.

Then, if treatment of a desired region proceeds by the pedal of the footswitch 16 being further pressed uninterruptedly, the value of the phasedifference Δθ calculated by the first controller 102 takes a fixed valuenear 90° shown in FIG. 8, for example, after the time t1.

In this modification, the first controller 102 is not limited to theabove control exercised when detecting that the phase difference Δθ hasbecome a fixed value near 90° and may be, for example, the above controlexercised when detecting that the phase difference Δθ has become a fixedpredetermined value greater than 45° and equal to or less than 90°.

Energy input into the body tissues L1, L2 may be switched by combiningthe change of the impedance Z and the change of the phase θ. That is, itis also preferable to appropriately set by the display unit 108 and usethe change of the impedance Z and the change of the phase θ such as avalue which is the earlier or the later of reaching a threshold.

Next, a second modification of the first embodiment will be describedusing FIGS. 10A and 10B. A case when high-frequency energy is used fortreatment is described in the above embodiment, but in the presentembodiment, a case when thermal energy by a heater is used for treatmentwill be described.

As shown in FIG. 10A, a plate-like heater (energy output portion) 222 isdisposed on a main body 62 of a first holding member 52. The heater 222is enclosed with a holding surface 62 a of the main body 62. As shown inFIG. 10B, a plate-like heater (energy output portion) 232 is disposed ona main body 72 of a second holding member 54. The heater 232 is enclosedwith a holding surface 72 a of the main body 72.

In a display unit 108, various settings are made, for example, thehighest temperature of heaters 222, 232, the output time of energy froma high-frequency energy output portion 104 to the heaters 222, 232, athreshold T1 of the end temperature (here, the surface temperature ofthe body tissues L1, L2) of treatment of body tissues and the like areset. In this state, treatment using the heaters 222, 232 is provided inthe same manner as the treatment using the first and secondhigh-frequency electrodes 92, 94. In this case, treatment proceeds whilemeasuring the temperature of the body tissue in contact with the heaters222, 232.

Next, a third modification of the first embodiment will be describedusing FIGS. 11A to 11C. A case when high-frequency energy or thermalenergy of heating by heaters 222, 232 is used for treatment is describedin the above embodiments, but in the present embodiment, a case whenthermal energy by laser light is used for treatment will be described.

As shown in FIGS. 11A to 11C, the first holding member 52 includes aheat exchanger plate (energy output portion) 282, instead of ahigh-frequency electrode 92, disposed therein. The heat exchanger plate282 has a concave 282 a formed therein. A diffuser 284 as an outputmember or an energy output portion is disposed in the concave 282 a ofthe heat exchanger plate 282. A fiber (energy output portion) 286 isinserted into the diffuser 284. Thus, if laser light is incident to thefiber 286, the laser light is diffused to the outside from the diffuser284. Energy of the laser light is converted into thermal energy by theheat exchanger plate 282 being irradiated therewith. Thus, heat isconducted through the heat exchanger plate 282 so that body tissues canbe treated.

The second holding member 54 is different only in the projection 202 andthe recess 206 and so an illustration thereof is omitted.

Next, a fourth modification of the first embodiment will be describedusing FIG. 12. A case when a bipolar energy treatment device 12 is usedis described in the above embodiments, but the present embodiment is anexample of using a monopolar treatment device.

In such a case, as shown in FIG. 12, a return electrode plate 150 ismounted on a patient P to be treated. The return electrode plate 150 isconnected to the energy source 14 via an electrical connection line 150a. Further, the high-frequency electrode 92 disposed on the firstholding member 52 and the high-frequency electrode 94 disposed on thesecond holding member 54 are in a state of the same electric potentialin which the electrical connection lines 28 a, 28 b are electricallyconnected. In this case, each area of the body tissues L1, L2 in contactwith the high-frequency electrodes 92, 94 is sufficiently smaller thanthe area where the return electrode plate 150 is in contact with theliving body and so a current density is increased, but the currentdensity in the return electrode plate 150 depresses. Thus, while thebody tissues L1, L2 held by the first and second holding members 52, 54are heated by Joule heat, heating of body tissues in contact with thereturn electrode plate 150 is so small to be ignorable. Therefore, amongthe body tissues L1, L2, grasped by the first and second holding members52, 54, only a portion thereof in contact with the high-frequencyelectrodes 92, 94 at the same potential is heated and denatured.

In the present embodiment, a case when the body tissues L1, L2 aretreated by using high-frequency energy has been described, but energyof, for example, a microwave may also be used. In such a case, thehigh-frequency electrodes 92, 94 can be used as microwave electrodes.

Next, a fifth modification of the first embodiment will be describedusing FIG. 13. The above embodiments have been described by taking alinear type energy treatment device 12 (see FIG. 1) to treat bodytissues L1, L2 in an abdominal cavity (in the body) through an abdominalwall as an example, but the present modification is, for example, asshown in FIG. 13, an open linear type energy treatment device (medicaltreatment device) 12 a that extracts tissues to be treated out of thebody through the abdominal wall for treatment.

The energy treatment device 12 a includes the handle 22 and thetreatment portion (holding portion) 26. That is, in contrast to theenergy treatment device 12 (see FIG. 1) for treatment through theabdominal wall, the shaft 24 is removed. On the other hand, a memberhaving the same action as the shaft 24 is disposed inside the handle 22.Thus, the energy treatment device 12 a shown in FIG. 13 can be used inthe same manner as the energy treatment device 12 shown in FIG. 1described above.

An adhesive may be directly supplied into body tissues by an injectorsuch as a syringe instead of using the fluid reservoir 122. As a supplymethod of adhesive, the flow rate adjuster 124 may control the flow rateof adhesive into body tissues by using a rotary pump or the like. Thoughnot specifically described, it is permitted to directly supply anadhesive or the like into body tissues by an injector such as a syringealso in embodiments described below.

[Second Embodiment]

Next, the second embodiment will be described using FIGS. 14 to 19. Thepresent embodiment is a modification of the first embodiment and thesame reference numerals are attached to the same members as those usedin the first embodiment or members achieving the same action as theaction of those in the first embodiment and a description of suchmembers is omitted.

As shown in FIG. 14, a handle 22 of an energy treatment device 12 bincludes a cutter driving knob 34 to move a cutter (auxiliary treatmentdevice) 180 described later while being installed adjacent to thetreatment portion opening/closing knob 32.

As described in FIG. 15, in addition to a detector (called a firstdetector here) 106 described in the first embodiment, a second detector107 is connected to a first controller 102 in an energy source 14. Thesecond detector 107 is connected to a sensor 185 disposed in lockingportions 184 a, 184 b, 184 c of a long groove 184 described later of thecutter 180 shown in FIGS. 16A and 16B.

In the present embodiment, as shown in FIGS. 17A and 17B, recesses 62 b,64 a (see FIGS. 4A to 4C) and a projection 202 (see FIGS. 4A to 4D) areremoved from a main body 62 of a first holding member 52. A recess 206(see FIGS. 5A to 5C) is removed from a main body 72 of a second holdingmember 54.

As shown in FIGS. 16A to 17B, the straight cutter guiding groove 172 isformed on the main body 62 and the base 64 of the first holding member52 closer to the second holding member 54. Similarly, the straightcutter guiding groove 174 is formed on the main body 72 and the base 74of the second holding member 54 closer to the first holding member 52. Acutter 180 (see FIGS. 18A to 18B) described later is configured toadvance to/retreat from these cutter guiding grooves 172, 174.

As shown in FIG. 17A, high-frequency electrodes 92, 94 disposed on themain bodies 62, 72 of the first and second holding members 52, 54 areformed, for example, in a substantial U shape and each have two ends inthe proximal end of the main bodies 62, 72 of the first and secondholding members 52, 54. That is, each of the high-frequency electrodes92, 94 is formed continuously. The high-frequency electrodes 92, 94 havecutter guiding grooves (reference numerals 172, 174 are convenientlyattached) to guide the cutter 180 formed together with the first andsecond holding members 52, 54.

The cutter guiding grooves 172, 174 of the first and second holdingmembers 52, 54 are formed in a mutually opposite state along the axialdirection of the shaft 24. Then, the cutter 180 can be guided by the twocollaborating cutter guiding grooves 172, 174 of the first and secondholding members 52, 54.

The cutter guiding groove 172 of the first holding member 52 is formedon the center axis of the main body 62 and the base 64 of the firstholding member 52 and the cutter guiding groove 174 of the secondholding member 54 is formed on the center axis of the main body 72 andthe base 74 of the second holding member 54.

A driving rod 182 is movably disposed inside a pipe 42 of the shaft 24along the axis direction thereof. The cutter driving knob 34 is disposedat the proximal end of the driving rod 182. The cutter (auxiliarytreatment device) 180 is disposed at the tip end of the driving rod 182.Thus, if the cutter driving knob 34 is operated, the cutter 180 movesalong the axial direction of the shaft 24 via the driving rod 182.

As shown in FIG. 18A, the cutter 180 has a cutting edge 180 a formed atthe tip end thereof and As shown in FIGS. 16A and 16B, the tip end ofthe driving rod 182 is fixed to the proximal end thereof. A long groove184 is formed between the tip end and the proximal end of the cutter180. In the long groove 184, a movement regulation pin 42 a extending ina direction perpendicular to the axial direction of the shaft 24 isfixed to the pipe 42 of the shaft 24. Thus, the long groove 184 of thecutter 180 moves along the movement regulation pin 42 a. Therefore, thecutter 180 moves straight. At this point, the cutter 180 is disposed inthe cutter guiding grooves (channels, fluid discharge grooves) 172, 174of the first and second holding members 52, 54.

The locking portions 184 a, 184 b, 184 c to control the movement of thecutter 180 by locking the movement regulation pin 42 a are formed, forexample, at three locations of one end, the other end, and therebetween.The sensor 185 capable of recognizing the position of the movementregulation pin 42 a and also recognizing the direction of movement ofthe movement regulation pin 42 a is disposed in the long groove 184 ofthe cutter 180. Various kinds of sensors such as a sensor using lightand a contact type sensor are used as the sensor 185. Thus, it becomespossible to recognize that the cutting edge 180 a of the cutter 180 iscontained in the shaft 24 when the movement regulation pin 42 a ispositioned in the locking portion 184 a at the one end (tip end) of thelong groove 184 and the cutting edge 180 a of the cutter 180 is disposedin the cutter guiding grooves 172, 174 through the tip end of the shaft24 when the movement regulation pin 42 a is positioned at the other end(rear end) 184 b. Therefore, the second detector 107 can recognize theposition of the cutting edge 180 a of the cutter 180 with respect to theshaft 24 and a treatment portion 26 through the sensor 185 and caneasily determine whether the cutting edge 180 a of the cutter 180 is ina position to cut body tissues.

As shown in FIGS. 16A and 16B, the pipe 42 and a sheath 44 of the shaft24 of the energy treatment device 12 shown in FIGS. 15A and 15B includefluid discharge ports 186, 188 through which a fluid such as a steam(gas) or liquid (tissue fluid) described later is discharged formedrespectively. These fluid discharge ports 186, 188 are formed on therear end side of the shaft 24.

Though not shown, a connection mouthpiece is suitably provided on theouter circumferential surface of the fluid discharge port 188 of thesheath 44. At this point, the fluid described later is dischargedthrough the cutter guiding grooves 172, 174, the fluid discharge port186 of the pipe 42 of the shaft 24, the fluid discharge port 188 of thesheath 44 of the shaft 24, and the connection mouthpiece. In this case,a fluid such as a steam and liquid released from body tissues L1, L2 caneasily be discharged from the fluid discharge ports 186, 188 by suckingfrom inside the connection mouthpiece.

The fluid discharge ports 186, 188 are suitably provided in the shaft24, but may also be suitably provided in the handle 22.

As shown in FIG. 18B, a duct 216 is formed inside a cutter 180 along thelongitudinal direction of the cutter 180. The duct 216 formed inside thecutter 180 is connected to a hose 18 a through an inner portion of adriving rod 182. A plurality of openings (a conjugation maintenanceassistance portion) 216 a is formed in the center in a width directionon the side face of the cutter 180. Thus, a body tissue L_(T) is cut andat the same time, an adhesive is applied to the neighborhood of thejoint surface of a joined portion C. Therefore, the adhesive(conjugation adjunct) penetrates the joint surface of the joined portionC and is hardened. In this case, as shown in FIG. 18D, an increasingamount of adhesive penetrates with an adhesive being closer to the cutsurface S and a decreasing amount of adhesive penetrates with anadhesive being further away from the cut surface S.

Next, the action of a medical treatment system 10 according to thepresent embodiment will be described using FIG. 19.

As described in the first embodiment, a fluid (auxiliary joining agent)with which a joined body tissue L_(T) obtained after joining the bodytissues L1, L2 is coated is put into a fluid reservoir 122 of a fluidsource 18. A hose 18 a connected to the fluid reservoir 122 is closed bya flow rate adjustment mechanism 134 so that an adhesive should not flowtoward the energy treatment device 12.

The operator operates a display unit 108 of the energy source 14 inadvance to set output conditions for the medical treatment system 10(S201). The operator checks the output (set power Pset [W]) from ahigh-frequency energy output portion 104, a threshold Z1 [Ω] of animpedance Z by the detector 106, an energy supply time t1 [sec] and thelike through the display unit 108. If the output from the high-frequencyenergy output portion 104 or the threshold Z1 of the impedance Z by thedetector 106 should be set to a different value, the operator sets thevalue as desired and checks the value through the display unit 108. Theoperator also sets a flow rate V1 passed from the fluid reservoir 122 tothe energy treatment device 12 through the hose 18 a.

As shown in FIG. 16A, the treatment portion 26 and the shaft 24 of thesurgical treatment device 12 are inserted into the abdominal cavitythrough, for example, the abdominal wall while the second holding member54 is closed with respect to the first holding member 52. To hold thebody tissues L1, L2 to be treated by the first and second holdingmembers 52, 54, the operator operates the treatment portionopening/closing knob 32 of the handle 22 to hold the body tissues L1, L2to be treated between the first and second holding members 52, 54.

The operator operates the pedal of the foot switch 16 while the bodytissues L1, L2 are held between the first and second holding members 52,54. A signal is input into the first controller 102 from the foot switch16 and the first controller 102 of the energy source 14 determineswhether the switch 16 is changed to ON by the pedal thereof pressedthrough the operation of the operator (S202).

If the first controller 102 determines that the switch 16 is changed toON by the pedal thereof pressed, a signal is input into thehigh-frequency energy output portion 104 from the first controller 102.The high-frequency energy output portion 104 supplies energy to the bodytissues L1, L2 between the high-frequency electrodes 92, 94 throughelectrical connection lines 28 a, 28 b (S203). Then, a high-frequencycurrent is passed to the body tissues L1, L2 between the high-frequencyelectrodes 92, 94. Thus, an inner portion of the body tissues L1, L2 isdenatured (the body tissues L1, L2 are cauterized) while the bodytissues L1, L2 are heated and dehydrated and contact surfaces C1, C2 ofbody tissues L1, L2 are joined to form a joined portion C.

An exhausted fluid such as blood and vapor generated from the bodytissues L1, L2 in treatment in which the body tissues L1, L2 are heatedand dehydrated can be introduced into cutter guiding grooves 172, 174.Then, the exhausted fluid introduced into the cutter guiding grooves172, 174 can be guided out of the energy treatment device 12 b from thefluid discharge ports 186, 188 formed in the pipe 42 of the shaft 24 andthe sheath 44. Thus, fluid can be prevented from remaining on joinedsurfaces of the joined portion C of the body tissues L1, L2 as much aspossible and the body tissues L1, L2 can be treated for conjugation morequickly. Therefore, a sequence of treatment of joining the body tissuesL1, L2 and coating the joined portion C can be provided moreefficiently.

Then, the first controller 102 determines whether the impedance Z hasreached the threshold Z1 (S204) and stops the supply of thehigh-frequency energy when the impedance Z reaches the threshold Z1(S205).

Then, a buzzer sound (first buzzer sound) to tell the end of conjugationtreatment of the body tissues L1, L2 using high-frequency energy isemitted from a speaker 110 (S206).

Next, a medical doctor checks the first buzzer sound and then operatesthe cutter driving knob 34 shown in FIG. 14. That is, the medical doctoradvances the cutter 180 along the cutter guiding grooves 172, 174 fromthe states shown in FIGS. 16A and 16B. As the cutter 180 advances, aregion denatured and joined by the high-frequency electrodes 92, 94 willbe cut. At this point, the sensor 185 detects, for example, relativepositions of the locking portions 184 a, 184 b, 184 c with respect tothe movement regulation pin 42 a and conveys the detected relativepositions to the second detector 107. The second detector 107 recognizesthe position and direction of movement of the cutter 180 with respect tothe shaft 24 and the treatment portion 26 (S207).

If the direction of movement of the cutter 180 detected by the seconddetector 107 is recognized as a direction to cut the body tissue L_(T),the first controller 102 delivers a signal to a second controller 132 tocause the flow rate adjustment mechanism 134 to operate so that the hose18 a is opened (S208).

Thus, while the joined body tissue L_(T) is cut, an adhesive is oozedout from an opening 216 a of the cutter 180 to apply the adhesive to acut surface S. That is, as cutting of the body tissue L_(T) proceeds,adhesive oozed out from the opening 216 a of the cutter 180 is applied.

If it is assumed that the body tissues L1, L2 have the same thickness,adhesive is applied to a position deviating from joined surfaces of thejoined portion C. The applied adhesive flows in an appropriate directiondepending on the orientation of the first and second holding members 52,54 and thus, the adhesive is applied to the whole cut surface S by thecutter 180.

The adhesive also flows to the surface in contact with thehigh-frequency electrodes 92, 94 of the body tissue L_(T) to be appliedthere. Thus, the adhesive is applied to the whole exterior surface ofthe body tissue L_(T).

When a predetermined discharge of adhesive flows through a hose 18 a,the hose 18 a is closed (S210). When closing of the hose 18 a isrecognized, a buzz sound is issued (S211). Then, if the return of thecutter 180 to the original position is recognized by a sensor 185disposed in the cutter 180 after a cutter drive knob 34 being operated(S212), a buzz sound to tell the end of a sequence of treatment isissued by the speaker 110 (S213).

According to the present embodiment, as described above, the followingeffect is achieved.

A fluid such as blood arising from the body tissues L1, L2 duringtreatment can be put into the cutter guiding grooves 172, 174. Then, thefluid put into the cutter guiding grooves 172, 174 can be led to outsidethe energy treatment device 12 b from the fluid discharge ports 186, 188formed in the pipe 42 of the shaft 24 and the sheath 44. Thus, fluid canbe prevented from remaining on a joint surface of the joined portion Cof the body tissues L1, L2 as much as possible so that conjugationtreatment of the body tissues L1, L2 can be quickened. Therefore, asequence of the treatment to join the body tissues L1, L2 and to coatthe joined portion C can be carried out more efficiently.

Moreover, fluid can be prevented from seeping through into the joinedportion C of the body tissue L_(T) because not only the outercircumferential surface of the body tissue L_(T) to be joined can becoated with an adhesive, but also the adhesive can be applied to the cutsurface S of the body tissue L_(T) for coating of the joint surface.

The hose 18 a may be released to allow the adhesive to flow while thecutter 180 moves as described above, the hose 18 a may be released afterthe movement regulation pin 42 a of the pipe 42 reaches the lockingportion 184 b at the other end from the locking portion 184 a at the oneend of the long groove 184 through the intermediate portion 184 c. Inthis case, cutting of the body tissue L_(T) by a blade 180 a of thecutter 180 is completed (the cut surface S is already formed). Then,adhesive is allowed to flow while the movement regulation pin 42 a ofthe pipe 42 reaches the locking portion 184 a at the one end from thelocking portion 184 b at the other end of the long groove 184 throughthe intermediate portion 184 c. Then, a space is formed by the cutsurfaces S of the body tissues L_(T) when the blade 180 a of the cutter180 is drawn into the shaft 24 from the cutter guiding grooves 172, 174of the first and second holding members 52, 54. If the adhesive is oozedout from the openings 192 a, 194 a, the adhesive enters the spacebetween the cut surfaces S. Because the movement of the movementregulation pin 42 a of the pipe 42 between the locking portion 184 a atthe one end and the locking portion 184 b at the other end of the longgroove 184 of the cutter 180 can be detected by the sensor 185, thespatial relationship between the body tissue L_(T) to be joined and thecutter 180 can easily be grasped. Thus, the timing to close the hose 18a can appropriately be set by the flow rate adjustment mechanism 134.

The present embodiment has been described by taking a buzzer sound as asound emitted from the speaker 110, but treatment content or treatmentprocedures may be told in speech. It is preferable to make each soundeasily recognizable to know what kind of treatment is completed, likethe first buzzer sound and the second buzzer sound in the embodiment,which are considerably different.

In the present embodiment, a case when the cutter 180 is manuallyoperated by the cutter driving knob 34 has been described, meanwhile, itis also preferable to cut the body tissue L_(T) by automatically causingthe cutter 180 to operate without operating the cutter driving knob 34after the body tissues L1, L2 are treated for conjugation byhigh-frequency energy. That is, a sequence of treatment from the startof treatment using high-frequency energy to join the body tissues L1, L2to the end of treatment to coat the joined body tissue L_(T) mayautomatically be carried out.

Next, a first modification of the second embodiment will be describedusing FIGS. 20A and 20B.

The cutter 180 shown in FIG. 20A has ducts 212, 214 formed, for example,shown in the upper and lower parts in FIG. 20B, inside along thelongitudinal direction of the cutter 180. The ducts 212, 214 formedinside the cutter 180 are connected to a hose 18 a through an innerportion of a driving rod 182. As shown in FIGS. 20A and 20B, a pluralityof openings (conjugation sustainment assistance portions) 212 a, 214 aare formed at suitable intervals along the longitudinal direction of thecutter 180 on the side face of the cutter 180. These openings 212 a, 214a are communicatively connected to the ducts 212, 214. Thus, a fluidinvasion prevention substance (conjugation adjunct) to a body tissueL_(T) such as an adhesive can be discharged from the openings 212 a, 214a through the ducts 212, 214.

Thus, the opening 212 a is formed on the upper side of the up and down(height) direction orthogonal to the longer direction and width(thickness) direction of the cutter 180 and the opening 214 a is formedon the lower side and therefore, even if the thickness of the bodytissues L1, L2 is not uniform, adhesive can easily be caused to invadeinto joined surfaces of the joined portion C. Then, the adhesive isapplied to the surface Sc and the cut surface S of the joined portion Cfor coating.

Next, a second modification of the second embodiment will be describedusing FIGS. 21A to 21C.

Instead of channels (recesses) 62 b and 72 b (see FIGS. 4A to 4C), firstfluid conduits 162 and 164 having insulating properties is disposed onmain bodies 62 and 72 of first and second holding members 52 and 54shown in FIGS. 21A to 21C.

The first fluid conduit 162 is disposed on a ring shape in a positionclose to the surface of the high-frequency electrode 92 along edges ofthe outer circumference of the main body 62. As shown in FIG. 21C, thetransverse section of the first fluid conduit 162 is formed, forexample, in a circular shape or rectangular shape. The first fluidconduit 162 preferably has an appropriate elasticity so as to be inclose contact with an exterior surface of the body tissue L1 when thebody tissues L1, L2 are held by the first and second holding members 52,54. The first fluid conduit 162 is connected to the duct 64 a of thebase 64 of the first holding member 52. Incidentally, the high-frequencyelectrode 92 is disposed inside the first fluid conduit 162.

The first fluid conduit 162 includes a plurality of openings (a joincondition sustainment assistance portion) 162 a at suitable intervals.As shown in FIGS. 21B and 21C, these openings 162 a are directed towardthe surface of the high-frequency electrode 92 and also directed towardthe center axis of the high-frequency electrode 92. Thus, a fluiddischarged from the openings 162 a of the fluid conduit 162 can bepassed along the surface of the high-frequency electrode 92 toward thecenter axis of the high-frequency electrode 92.

Because, as shown in FIG. 21A, the openings 162 a of the fluid conduit162 are positioned close to the surface of the high-frequency electrode92, a portion of the fluid conduit 162 is projected from the surface ofthe high-frequency electrode 92. Thus, the fluid conduit 162 serves as abarrier portion that prevents a fluid such as a steam from being leakedto the outside, the fluid such as a steam being generated from the bodytissues L1, L2 when the body tissues L1, L2 are treated using thehigh-frequency electrode 92.

Though not illustrated, a fluid conduit 164 having an opening(conjugation maintenance assistance portion) 164 a is also disposed atan edge of the main body 72 of the second holding member 54symmetrically with respect to the first holding member 52. Thus, thefluid conduit 164 serves as a barrier portion that prevents a fluid suchas vapor generated in the body tissues L1, L2 from leaking to theoutside when the body tissues L1, L2 are treated by using thehigh-frequency electrode 94. The fluid conduit 164 is connected to theduct 74 a of the base 74 of the second holding member 54.

Though not illustrated, the fluid conduit 162 is formed as a doublelumen and it is preferable that one (inner side) be a duct having theopening 162 a and the other (outer side) be a duct through which a gasor liquid as a coolant flows. In this case, by causing the other duct(duct on the outer side) to circulate the coolant, the portion of thebody tissues L1, L2 in contact with the fluid conduit 162 can be cooled.Thus, heat can be prevented from being conducted to the outside ofholding surfaces 62 a, 72 a of the first and second holding members 52,54 through the body tissues L1, L2 and thus, the body tissues L1, L2outside the body tissues L1, L2 to be treated can reliably be preventedfrom being affected.

As shown in FIG. 21B, second fluid conduits 192, 194 having insulatingproperties are disposed at edges of the cutter guiding grooves 172, 174.The second fluid conduit 192 is connected to, for example, the duct 64 aof the base 64 of the first holding member 52. Similarly, the othersecond fluid conduit 194 is connected to, for example, the duct 74 a ofthe base 74 of the second holding member 54.

The second fluid conduits 192, 194 each have a plurality of openings(conjugation sustainment assistance portions) 192 a, 194 a atappropriate intervals. The openings 192 a, 194 a of the second fluidconduits 192, 194 are oriented toward the same second fluid conduits192, 194 opposite to each other across the cutter 180.

The second fluid conduits 192, 194 each have a pair thereof or each haveone fluid conduit bent in a substantial U shape.

In the present embodiment, a structure in which the fluid conduits 162,192 are provided in the first holding member 52 and the fluid conduits164, 194 are provided in the second holding member 54 is described, butthese fluid conduits 162, 164, 192, 194 may not be provided.

Also in the present embodiment, an example in which the opening 216 ashown in FIGS. 18A and 18B is formed on the side face of the cutter 180is shown, but the openings 212 a, 214 a shown in FIGS. 20A and 20B arealso preferably formed. In this case, an adhesive can be made to beeasily infiltrated into the joined surfaces C1, C2 when the body tissuesL1, L2 that are mutually different in thickness are joined.

Next, a third modification of the second embodiment will be describedusing FIGS. 22A and 22B.

A plurality of heaters (energy output portions) 242 is disposed on theback side of the high-frequency electrode 92 disposed in the main body62 of the first holding member 52 shown in FIG. 22A. Similarly, thoughnot shown, a plurality of heaters (energy output portions) 252 isdisposed on the back side of the high-frequency electrode 94 disposed inthe main body 72 of the second holding member 54. The heaters 242, 252can be controlled by the high-frequency energy output portion 104. Thatis, the high-frequency energy output portion 104 can supply energy tothe high-frequency electrodes 92, 94 and also to the heaters 242, 252.Incidentally, energy may be made selectively suppliable to both of thehigh-frequency electrodes 92, 94 and also to the heaters 242, 252 orenergy may be made suppliable simultaneously.

The high-frequency electrodes 92, 94 are each formed from a materialhaving a high thermal conductivity and thus, if the heaters 242, 252 areheated by supplying energy from the high-frequency energy output portion104 to the heaters 242, 252, heat is conducted from the heaters 242, 252to the high-frequency electrodes 92, 94. The heat conducted to thehigh-frequency electrodes 92, 94 is spread, for example, concentricallyfrom the heaters 242, 252.

In the present embodiment, a case when the heaters 242, 252 are disposedon the back side of the high-frequency electrodes 92, 94 is described,but the high-frequency electrodes 92, 94 may wholly be replaced by theheaters.

[Third Embodiment]

[Next, the third embodiment will be described using]FIGS. 23A to 26B.The present embodiment is a modification of the first and secondembodiments and the same reference numerals are attached to the samemembers or members achieving the same action as those described in thefirst and second embodiments and a detailed description thereof isomitted.

As shown in FIGS. 25A and 25B, a base 64 of a first holding member 52 ispivotally supported by a support pin 83 so as to be rotatable withrespect to a pipe 42. The support pin 83 is disposed in parallel with asupport pin 82 described in the first embodiment. Like an elastic member84 of a base 74 of a second holding member 54, the base 64 of the firstholding member 52 is energized by an elastic member 85 like a platespring. In the present embodiment, as shown in FIGS. 23A and 25B, thefirst holding member 52 and the second holding member 54 are preferablyopened symmetrically with respect to a shaft 24 in a treatment portion26 of an energy treatment device 12 c.

In the present embodiment, as shown in FIGS. 23A, 24, 25A, and 25B, apipe-shaped member (join condition sustainment assistance portion) 272is disposed as an auxiliary treatment device instead of a cutter 180(see FIGS. 16A and 16B). The proximal end of the pipe-shaped member 272is connected, as shown in FIGS. 25A and 25B, to a hose 18 a.

As shown in FIG. 25B, a plurality of side holes 272 a is formed on theside of a tip portion of the pipe-shaped member 272. The pipe-shapedmember 272 can move between inside the shaft 24 and inside the treatmentportion 26 by operating a pipe-shaped member movement knob 36 disposedon a handle 22 and can detect the position of the pipe-shaped member 272relative to the treatment portion 26 or the shaft 24.

As shown in FIGS. 26A and 26B, a main body 62 of a first holding member52 has a recess (pipe-shaped member guiding groove) 62 c forming a spaceto move the pipe-shaped member 272 forward and backward formed therein.The width of the recess 62 c is preferably formed slightly larger thanan outside diameter of the pipe-shaped member 272. A high-frequencyelectrode 92 a is also disposed on the recess 62 c. The high-frequencyelectrode 92 a disposed on the recess 62 c and a high-frequencyelectrode 92 c disposed on an inner side of a holding surface 62 a ofthe main body 62 are at the same potential.

Incidentally, a recess 72 c is also formed, as shown in FIG. 26B, in amain body 72 of a second holding member 54 and a high-frequencyelectrode 94 b at the same potential as a high-frequency electrode 94 isdisposed on the recess 72 c.

Next, the action of a medical treatment system 10 according to thepresent embodiment will be described.

As shown in FIG. 26B, the pipe-shaped member 272 of the energy treatmentdevice 12 c is arranged between body tissues L1, L2 to be joined. Then,the body tissues L1, L2 are held by the main bodies 62, 72 of the firstand second holding members 52, 54 and the pipe-shaped member 272 issandwiched between the body tissues L1, L2.

In this state, a substance (conjugation adjunct), such as an adhesive,that prevents fluid from invading the body tissue L_(T) is introducedfrom a fluid reservoir 122 to the pipe-shaped member 272 through a hose18 a. Thus, the substance that prevents fluid from invading the bodytissue L_(T) is applied to the body tissues L1, L2 from the side holes272 a of the pipe-shaped member 272. In this state, the pipe-shapedmember 272 is pulled out from between the main bodies 62, 72 of thefirst and second holding members 52, 54 by operating the pipe-shapedmember movement knob 36. Thus, contact surfaces C1, C2 of the bodytissues L1, L2 are in contact via the substance that prevents fluid frominvading the body tissue L_(T).

Then, energy is supplied from a high-frequency energy output portion 104to high-frequency electrodes 92, 94. Thus, the substance that preventsfluid from infiltrating the body tissue L_(T) on the joint surface isheated and also the joint surfaces are joined.

As more energy is supplied to the high-frequency electrodes 92, 94 orthe supply of energy is stopped, the substance that prevents fluid frompenetrating the body tissue L_(T) is hardened. At this point, thesubstance disposed on the joint surface of the body tissues L1, L2 toprevent fluid from penetrating the body tissue L_(T) penetrates from thecontact surfaces C1, C2 of the body tissues L1, L2 toward thehigh-frequency electrodes 92, 92 b, 94, 94 b. Thus, the substance thatprevents fluid from penetrating the body tissue L_(T) acts to sustainthe joined state of the body tissues L1, L2.

According to the present embodiment, as described above, the followingeffect is achieved.

A fluid invasion prevention substance to the body tissue L_(T) candirectly be applied to between the body tissues L1, L2. That is, thesubstance that reliably prevents fluid from penetrating the body tissueL_(T) can be applied to between the contact surfaces C1, C2 of the bodytissues L1, L2.

Thus, when the body tissues L1, L2 are joined using high-frequencyenergy or the like, since the substance that prevents fluid frompenetrating the body tissue L_(T) is disposed between the contactsurfaces C1, C2, even if a force to release joining of the body tissuesL1, L2 acts, fluid can be prevented from penetrating the joint surfaceof the body tissues L1, L2 so that the joined state can be sustained.

Next, a first modification of the third embodiment will be describedusing FIG. 27.

That is, the present embodiment is described by assuming that instead ofa cutter 180, a pipe-shaped member 272 is used, but an ultrasonictransducer 276 (see FIG. 27) may be disposed at an end face of thepipe-shaped member 272. That is, the pipe-shaped member 272 functions asan energy output portion that outputs ultrasonic energy to the bodytissues L1, L2. In this case, after pretreatment to cause collagen to beexposed on contact surfaces C1, C2 of the body tissues L1, L2 byultrasonic treatment using the pipe-shaped member 272, the body tissuesL1, L2 can be bonded by a substance that prevents fluid from invadinginto the body tissue L_(T).

Next, a second modification of the third embodiment will be describedusing FIGS. 28 to 29C. Here, an example using heaters 222, 232 (seeFIGS. 10A and 10B) will be described, but high-frequency electrodes mayalso be used.

In the present modification, a mesh or porous coating member (which ismelted when heated and applied, invaded, and cured in the body tissuesL1, L2 like an adhesive) may be used on the outer circumferentialsurface of the body tissues L1, L2 when high-frequency electrodes areused for treatment and further a sheet coating member may also be usedwhen heaters are used for treatment.

A medical treatment system 10 according to the present embodimentincludes an energy treatment device 12 and an energy source 14 and acase when a fluid source 18 is removed from the medical treatment systemwill be described here. In addition, a case when mainly the heaters 222,232 (see FIGS. 10A and 10B) are used, instead of high-frequencyelectrodes 92, 94, will be described.

As shown in FIG. 28A, a coating member (sheet member) 224 (see FIG. 28B)whose transverse section is formed in a C shape is disposed on the outercircumference of the main body 62 of the first holding member 52.

As shown in FIGS. 29A to 29C, a portion of the coating member 224 incontact with the heater 222 has various shapes like non-porous sheet,mesh, and porous shapes. The coating member 224 contains components ofthe conjugation adjunct described in the first embodiment and a heatedportion thereof is melted when heated to an appropriate temperature andcomponents of the conjugation adjunct spread to the surface of bodytissues or infiltrate and are cured while spread on the surface of bodytissues or infiltrated when cooled. When cured, as described in thefirst embodiment, the action of preventing fluid from infiltrating tocontact surfaces described later or the like from outside body tissuesis achieved.

The coating member 224 is suitably expandable at least in thecircumferential direction (width direction orthogonal to the longerdirection of the main body 62 of the first holding member 52) beforeheating (for example, states like non-porous sheet, mesh, and porousshapes). Then, when the coating member 224 is disposed in the main body62 of the first holding member 52, the coating member 224 can be broughtinto close contact with the holding surface 62 a of the main body 62 ofthe first holding member 52 and an exterior surface detached from thesecond holding member 54 of the main body 62.

Coating members (conjugation maintenance assistance portions) 224, 234are disposed between the body tissues L1, L2 and the heaters 222, 232when the body tissues L1, L2 are held by the main bodies 62, 72 of thefirst and second holding members 52, 54 and so are pressed toward theheaters 222, 232 by the body tissues L1, L2. Thus, when the body tissuesL1, L2 are held by the first and second holding members 52, 54, thecoating members 224, 234 come into contact with the heaters 222, 232.

Ends of the coating member 224 disposed in the first holding member 52may be opposed to each other in positions of the main body 62 of thefirst holding member 52 detached from the main body 72 of the secondholding member 54 or may partially be overlapping. The heater 232 andthe coating member 234 are also disposed in the second holding member54. In this case, the heater 232 and the coating member 234 are suitablydisposed in the same manner as in the first holding member 52.

A substance that prevents fluid from invading into the body tissue L_(T)is gradually cured by being cooled by the stop of energy supply. Then,the substance that prevents fluid from invading into the body tissueL_(T) is sustained in a state in which the joined body tissues L_(T) arecoated with the substance.

Portions of the coating members 224, 234 that are not in contact withthe heaters 222, 232 preferably sustain a state of being disposed in themain bodies 62, 72 of the first and second holding members 52, 54. Thatis, the coating member 224 disposed in the first holding member 52maintains a state in which the side detached from the holding surface 62a of the main body 62 with respect to the second holding member 54 isdisposed on the outer circumferential surface of the main body 62. Also,the coating member 234 disposed in the second holding member 54 sustainsa state in which the side detached from the holding surface 72 a of themain body 72 with respect to the first holding member 52 is disposed onthe outer circumferential surface of the main body 72.

The porous coating members 224, 234 shown in FIG. 29B or mesh coatingmembers 224, 234 shown in FIG. 29C are used, instead of the heaters 222,232, the high-frequency electrodes 92, 94 may be used for treatment. Ifthe porous coating members 224, 234 shown in FIG. 29B are used, aportion of the high-frequency electrodes 92, 94 comes into contact withthe body tissues L1, L2. If the mesh coating members 224, 234 shown inFIG. 29C are used, a portion of the high-frequency electrodes 92, 94comes into contact with the body tissues L1, L2. Thus, when the porouscoating members 224, 234 or the mesh coating members 224, 234 are used,the high-frequency electrodes 92, 94 or the heaters 222, 232 may beused.

On the other hand, if the non-porous sheet coating members 224, 234 areused, the high-frequency electrodes 92, 94 do not come into contact withthe body tissues L1, L2 and thus, it is preferable to use the heaters222, 232 in this case. Incidentally, if a hole can be provided by aprojection 202 provided in the high-frequency electrode 92 in a portionof the non-porous sheet coating members 224, 234 so that thehigh-frequency electrodes 92, 94 can directly be brought into contactwith the body tissues L1, L2, as will be described below, treatmentusing high-frequency energy will also be possible.

[Fourth Embodiment]

Next, the fourth embodiment will be described using FIGS. 30 to 33C. Thepresent embodiment is a modification of the first to third embodiments.Here, the present embodiment will be described by taking a circular typebipolar energy treatment device (medical treatment device) 12 d fortreatment, for example, through or outside the abdominal wall as anexample of the energy treatment device will be described.

As shown in FIG. 30, the energy treatment device 12 d includes a handle322, a shaft 324, and a treatment portion (holding portion) 326 that canbe opened and closed. An energy source 14 is connected to the handle 322via a cable 28 and also a fluid source 18 connected to the handle 322via a hose 18 a.

A treatment portion opening/closing knob 332 and a cutter driving lever334 are disposed on the handle 322. The treatment portionopening/closing knob 332 is rotatable with respect to the handle 322. Ifthe treatment portion opening/closing knob 332 is rotated, for example,clockwise with respect to the handle 322, a detachable-side holdingmember 354 described later of the treatment portion 326 is detached froma main body-side holding member 352 (see FIG. 33B) and if the treatmentportion opening/closing knob 332 is rotated counterclockwise, thedetachable-side holding member 354 is brought closer to the mainbody-side holding member 352 (see FIG. 33A).

The shaft 324 is formed in a cylindrical shape. In consideration ofinsertability into body tissues, the shaft 324 is made to be curvedappropriately. It is, needless to say, that the shaft 324 is alsosuitably formed in a straight shape.

The treatment portion 326 is disposed at the distal end of the shaft324. As shown in FIGS. 33A and 33B, the treatment portion 326 includesthe main body-side holding member (first holding member) 352 formed atthe distal end of the shaft 324 and the detachable-side holding member(second holding member) 354 detachable from the main body-side holdingmember 352.

The main body-side holding member 352 includes a cylinder body 362, aframe 364, an electrical connection pipe 366, a cutter 368, a cutterpusher 370, and first and second fluid ducts 372, 374. The cylinder body362 and the frame 364 have insulating properties. The cylinder body 362is coupled to the distal end of the shaft 324. The frame 364 is disposedin a state of being fixed with respect to the cylinder body 362.

The frame 364 has a center axis which is opened. The electricalconnection pipe 366 is disposed in the opened center axis of the frame364 movably within a predetermined range along the center axis of theframe 364. If the treatment portion opening/closing knob 332 of thehandle 322 is rotated, as shown in FIGS. 33A and 33B, the electricalconnection pipe 366 can move within the predetermined range through, forexample, ball screw (not shown) action. The electrical connection pipe366 has a projection 366 a projecting inwards in a diameter directionformed thereon so that a connector 382 a of an electrical connectionshaft 382 described later can be engaged and released.

A fluid duct 374 to pass a fluid to the detachable-side holding member354 is disposed inside the electrical connection pipe 366. Like theelectrical connection pipe 366, the fluid duct 374 is movable within apredetermined range.

As shown in FIGS. 31B and 33B, a space is formed between the cylinderbody 362 and the frame 364. The cutter 368 in a cylindrical shape isdisposed in the space between the cylinder body 362 and the frame 364.The proximal end of the cutter 368 is connected to the tip portion ofthe cutter pusher 368 a disposed inside the shaft 324. The cutter 368 isfixed to the outer circumferential surface of the cutter pusher 370.Though not shown, the proximal end of the cutter pusher 370 is connectedto the cutter driving lever 334 of the handle 322. Thus, if the cutterdriving lever 334 of the handle 322 is operated, the cutter 368 movesvia the cutter pusher 370.

A first fluid airway (fluid channel) 376 is formed between the cutterpusher 370 and the frame 364. Also, a fluid discharge port (not shown)which is configured to discharge a fluid passing through the first fluidairway 376 to the outside is formed in the shaft 324 or the handle 322.

As shown in FIGS. 31B and 32, a first high-frequency electrode 378 in anannular shape is formed as an output member or an energy discharge unitat the tip end of the cylinder body 362. The tip end of a firstelectrical connection line 378 a is fixed to the first high-frequencyelectrode 378. The first electrical connection line 378 a is connectedto the cable 28 via the main body-side holding member 352, the shaft324, and the handle 322.

As shown in FIG. 32, recesses (conjugation maintenance assistanceportion) 379 are formed in the first high-frequency electrode 378 at thetip of the main body-side holding member 352. Each of the recesses 379is formed in such a way that a projection 391 of a second high-frequencyelectrode 390 described later and disposed in the detachable-sideholding member 354 is accepted in a non-contact manner.

An edge 362 a of the cylinder body 362 is formed in a position higherthan the first high-frequency electrode 378 on the outer side of thefirst high-frequency electrode 378. That is, the edge 362 a of the mainbody-side holding member 352 is closer to a head portion 384 describedlater of the detachable-side holding member 354 than the firsthigh-frequency electrode 378.

The length of the projection 391 of the second high-frequency electrode390 of the detachable-side holding member 354 is formed to a height thatdoes not come into contact with the recess 379 of the firsthigh-frequency electrode 378 of the main body-side holding member 352.In other words, the depth of the recess 379 of the first high-frequencyelectrode 378 is formed deeper (longer) than the length of theprojection 391 of the second high-frequency electrode 390.

The detachable-side holding member 354 includes the electricalconnection shaft 382 having the connector 382 a, the head portion 384,and a fluid duct 386. The head portion 384 is formed in a substantiallysemi-spherical shape. The connector 382 a of the electrical connectionshaft 382 is formed on the side closer to one end of the electricalconnection shaft 382. The electrical connection shaft 382 has a circulartransverse section, one end thereof is formed in a tapering shape, andthe other end is fixed to the head portion 384. The connector 382 a ofthe electrical connection shaft 382 is formed in a concave shapeenabling engagement with the projection 366 a of the electricalconnection pipe 366 on the side closer to one end of the electricalconnection shaft 382. The outer circumferential surface of a portionother than the connector 382 a of the electrical connection shaft 382 isinsulated by coating or the like.

The electrical connection shaft 382 has first and second ducts 388 a,388 b formed so that one end and the other end are cut through. Thefirst duct 388 a is formed so that the center axis of the electricalconnection shaft 382 is cut through. The first duct 388 a iscommunicatively connected to the fluid duct 374 of the main body-sideholding member 352 when the connector 382 a of the electrical connectionshaft 382 of the detachable-side holding member 354 is fitted into theprojection 366 a of the electrical connection pipe 366 of the mainbody-side holding member 352. The second duct 388 b is communicativelyconnected to the second fluid airway (fluid path) 380 between theelectrical connection pipe 366 and the fluid duct 374.

The head portion 384 has an edge 384 a formed thereon. A secondhigh-frequency electrode 390 in an annular shape is disposed as anoutput member or an energy discharge unit on the inner side of the edge384 a. One end of a second electrical connection line 390 a is fixed tothe second high-frequency electrode 390. The other end of the secondelectrical connection line 390 a is electrically connected to theelectrical connection shaft 382.

As shown in FIGS. 31B and 33B, the second high-frequency electrode 390has a plurality of projections 391 disposed, for example, at equalintervals. If the detachable-side holding member 354 is brought closerto the main body-side holding member 352, the projection 391 can bedisposed in a state in which the projection 391 is not in contact withthe recess 379 of the first high-frequency electrode 378.

The projection 391 is formed to an appropriate length so that a hole isformed in the body tissues L1, L2. The projection 391 does notnecessarily need to penetrate through the body tissues L1, L2 and thetip (distal end with respect to the high-frequency electrode 390) of theprojection 391 is suitably positioned closer to the high-frequencyelectrode 378 of the main body-side holding member 352 than the contactsurfaces C1, C2 of the body tissues L1, L2.

As shown in FIG. 33C, each of the projections 391 has one or a pluralityof openings 391 a formed therein. Each of the projections 391 preferablyhas a plurality of openings 391 a formed therein. The projection 391 iscommunicatively connected to the first duct 388 a and the second fluidduct 374 and can ooze out a fluid (conjugation adjunct) such as anadhesive through the opening 391 a. The projections 391 are preferablydisposed, for example, at equal intervals or in such a way that the sameamount of liquid is oozed out from the opening 391 a of each of theprojections 391 by adjusting, for example, the diameter of the opening391 a.

A fluid discharge groove 392 in an annular shape is formed between theedge 384 a of the head portion 384 and the second high-frequencyelectrode 390. The fluid discharge groove 392 is communicativelyconnected to the second duct 388 b of the electrical connection shaft382. The surface of the second high-frequency electrode 390 is in astate of being drawn to the edge 384 a of the head portion 384. That is,the contact surface of the edge 384 a of the detachable-side holdingmember 354 is closer to the main body-side holding member 352 than thesecond high-frequency electrode 390. Thus, vapor and liquids dischargedfrom the body tissues L1, L2 in contact with the second high-frequencyelectrode 390 flow into the fluid discharge groove 392.

A cutter receiving portion 394 to receive the cutter 368 disposed on themain body-side holding member 352 is formed inside the secondhigh-frequency electrode 390 in an annular shape.

Further, the fluid discharge groove 392 is communicatively connected tothe head portion 384 and the second duct 388 b of the electricalconnection shaft 382. The second duct 388 b is communicatively connectedto the second fluid airway (fluid path) 380 of the electrical connectionpipe 366. The shaft 324 or the handle 322 has a fluid discharge port(not shown) formed to discharge a fluid flowing through the second fluidairway 380.

The electrical connection pipe 366 is connected to the cable 28 via theshaft 324 and the handle 322. Thus, when the connector 382 a of theelectrical connection shaft 382 of the detachable-side holding member354 is engaged with the projection 366 a of the electrical connectionpipe 366, the second high-frequency electrode 390 and the electricalconnection pipe 366 are electrically connected.

As shown in FIGS. 31A and 31B, the fluid duct 386 is disposed on theouter circumferential surface of the head portion 384 of thedetachable-side holding member 354. The fluid duct 386 is disposed onthe outer side of the edge 384 a head portion 384. Then, as shown inFIGS. 31B and 33B, an opening (conjugation maintenance assistanceportion) 386 a is formed in a portion of the fluid duct 386 disposed onthe outer side of the edge 384 a head portion 384 and a branch duct 386b to discharge a fluid through the second high-frequency electrode 390is formed inside the head portion 384. The fluid duct 386 iscommunicatively connected to the first duct 388 a from the outercircumferential surface of the head portion 384 of the detachable-sideholding member 354 to the inside of the electrical connection shaft 382.The branch duct 386 b of the fluid duct 386 is communicatively connectedto the first duct 388 a to branch from the first duct 388 a. The firstduct 388 a of the electrical connection shaft 382 is connected to thesecond fluid duct 374 disposed on the inner side of the electricalconnection pipe 366 of the main body-side holding member 352.

The electrical connection pipe 366 is connected to the cable 28 via theshaft 324 and the handle 322. Thus, when the connector 382 a of theelectrical connection shaft 382 is engaged with the projection 366 a ofthe electrical connection pipe 366, the second high-frequency electrode390 and the electrical connection pipe 366 are electrically connected.

Next, the action of a medical treatment system 10 according to thepresent embodiment will be described.

As shown in FIG. 33A, the treatment portion 326 and the shaft 324 of theenergy treatment device 12 c are inserted into the abdominal cavitythrough, for example, the abdominal wall while the main body-sideholding member 352 is closed with respect to the detachable-side holdingmember 354. The main body-side holding member 352 and thedetachable-side holding member 354 of the energy treatment device 12 care opposed across body tissues to be treated.

The treatment portion opening/closing knob 332 of the handle 322 isoperated to sandwich the body tissues L1, L2 to be treated between themain body-side holding member 352 and the detachable-side holding member354. At this point, the treatment portion opening/closing knob 332 ofthe handle 322 is rotated, for example, clockwise with respect to thehandle 322. Then, as shown in FIG. 33B, the electrical connection pipe366 is moved to the side of the distal end portion thereof with respectto the frame 364 of the shaft 324 of the electrical connection pipe 366.Thus, the interval between the main body-side holding member 352 and thedetachable-side holding member 354 increases so that the detachable-sideholding member 354 can be separated from the main body-side holdingmember 352.

Then, the body tissues L1, L2 to be treated are arranged between thefirst high-frequency electrode 378 of the main body-side holding member352 and the second high-frequency electrode 390 of the detachable-sideholding member 354. The electrical connection shaft 382 of thedetachable-side holding member 354 is inserted into the electricalconnection pipe 366 of the main body-side holding member 352. In thisstate, the treatment portion opening/closing knob 332 of the handle 322is rotated, for example, counterclockwise. Thus, the detachable-sideholding member 354 is closed with respect to the main body-side holdingmember 352. In this manner, the body tissues L1, L2 to be treated areheld between the main body-side holding member 352 and thedetachable-side holding member 354.

In this state, the foot switch or hand switch is operated to supplyenergy from the energy source 14 to each of the first high-frequencyelectrode 378 and the second high-frequency electrode 390 via the cable28. The first high-frequency electrode 378 passes a high-frequencycurrent to the second high-frequency electrode 390 via the body tissuesL1, L2. Thus, the body tissues L1, L2 between the first high-frequencyelectrode 378 and the second high-frequency electrode 390 are heated.

At this point, a fluid such as a vapor and a liquid arises from a heatedportion of the body tissues L1, L2. The surface of the firsthigh-frequency electrode 378 exposed to the side of the detachable-sideholding member 354 is positioned slightly lower than the edge 362 a ofthe main body-side holding member 352 while the first high-frequencyelectrode 378 is fixed to the main body-side holding member 352.Similarly, the surface of the second high-frequency electrode 390exposed to the side of the main body-side holding member 352 ispositioned slightly lower than the edge 384 a of the head portion 384 ofthe detachable-side holding member 354 while the second high-frequencyelectrode 390 is fixed to the detachable-side holding member 354.

Thus, the edge 362 a of the main body-side holding member 352 dischargesa fluid arising from the body tissue L1 in contact with the firsthigh-frequency electrode 378 to the second fluid airway 380 inside theelectrical connection pipe 366 through the fluid discharge groove 392and the second duct 388 b. Also, the edge 384 a of the detachable-sideholding member 354 discharges a fluid arising from the body tissue L2 incontact with the second high-frequency electrode 390 to the first fluidairway 376 between the cylinder body 362 and the frame 364. Therefore,the edge 362 a of the main body-side holding member 352 and the edge 384a of the detachable-side holding member 354 each serve the role as abarrier portion (dam) to prevent a fluid arising from the body tissuesL1, L2 from leaking to the outside of the main body-side holding member352 and the detachable-side holding member 354.

Then, while the main body-side holding member 352 and thedetachable-side holding member 354 are closed, a fluid arising from thebody tissue L1 flows into the first fluid airway 376 and a fluid arisingfrom the body tissue L2 flows into the second fluid airway 380 by theedge 362 a of the main body-side holding member 352 and the edge 384 aof the detachable-side holding member 354 being kept in contact. Thus, afluid arising from the body tissues L1, L2 is passed from the first andsecond fluid airways 376, 380 to the side of the handle 322 before beingdischarged to the outside of the energy treatment device 12 d.

After the body tissues L1, L2 being joined, an adhesive is allowed toflow through a fluid reservoir 122, the hose 18 a, the second fluid duct374, the first duct 388 a, the branch duct 386 b, and the opening 391 aof the projection 391. Then, the adhesive is infiltrated to the joinedsurfaces of the joined portion C from the opening 391 a of theprojection 391 and cured. That is, an adhesive containing a conjugationadjunct is applied to the joined surfaces of treated body tissues L1, L2and the joined portion C of the body tissue L_(T) is coated with theadhesive.

According to the present embodiment, as described above, the followingeffect is achieved.

By treating the body tissues L1, L2 for conjugation while measuring theimpedance Z of the body tissues L1, L2, close contact of the contactsurfaces C1, C2 of the body tissues L1, L2 can be made more reliable. Bycausing an adhesive or the like to infiltrate to the joined surfaces ofthe body tissue L_(T) treated for conjugation after the body tissues L1,L2 being treated for conjugation, the joined portion can be coated.Thus, fluid can be prevented from infiltrating to the joined portion Cof the body tissue L_(T) treated for conjugation. Therefore, a state inwhich the contact surfaces C1, C2 of the body tissues L1, L2 are inclose contact (state in which the body tissues L_(T) are joined) can besustained for a long time.

The present embodiment is described by taking a case when thehigh-frequency electrodes 378, 390 are used, but it is also preferableto use other types of energy such as heaters and laser light.

Next, a first modification of the fourth embodiment will be describedusing FIGS. 34 and 35. The present modification uses coating members396, 398 formed of components similar to those of coating members 224,234 described in the second modification of the third embodiment.

As shown in FIGS. 34 and 35, a main body-side holding member 352 and adetachable-side holding member 354 have coating members (join conditionsustainment assistance portions) 396, 398 in various sheet shapes suchas a nonporous shape, porous shape, and mesh shape containing aconjugation adjunct, instead fluid duct 386 (see FIGS. 31A to 33B)described in the fourth embodiment, disposed therein.

The coating members 396, 398 are each formed in a substantially annularshape. That is, the coating members 396, 398 have openings 396 a, 398 atherewithin. The opening 396 a of the coating member 396 disposed on themain body-side holding member 352 causes an electrical connection pipe366 of the main body-side holding member 352 to project. The opening 398a of the coating member 398 disposed on the detachable-side holdingmember 354 causes an electrical connection shaft 382 of thedetachable-side holding member 354 to project.

By providing treatment in this state, the outer circumference of thebody tissues L1, L2 can be coated so that fluid can be prevented frominfiltrating particularly to the joined portion C of the body tissuesL1, L2.

In the present embodiment, a case when high-frequency electrodes 378,390 are used has been described, but it is also preferable to use othertype of energy such as a heater and laser light.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

What is claimed is:
 1. A medical treatment apparatus to treat bodytissues for conjugation, the apparatus comprising: at least a pair ofholding members configured to hold the body tissues; an energy outputportion which is provided in at least one of the holding members, andwhich is configured to output energy from an energy source to the bodytissues held by the pair of holding members and configured to joincontact surfaces of the body tissues and form a joined portion; asupplying portion which is configured to supply a substance to preventfluid from invading at least the contact surfaces of the joined portionof the body tissues; and a controller which is configured to controloutput of the energy from the energy output portion, which is configuredto control stopping of the output of the energy from the energy outputportion after the joined portion has formed, and which is configured tocontrol supply of the substance from the supplying portion to thecontact surfaces of the body tissues.
 2. The medical treatment apparatusaccording to claim 1, wherein the supplying portion includes at leastone projection configured to penetrate the body tissues, and theprojection includes at least one opening.
 3. The medical treatmentapparatus according to claim 1, wherein a cutter configured to cut thebody tissues is disposed through the holding members.
 4. The medicaltreatment apparatus according to claim 3, wherein the cutter isconfigured to supply the substance, and the controller is configured tocontrol the cutter which is configured to advance to/retreat from theholding members between the holding members after the joined portion hasformed and the controller is configured to control energy output portionto stop an output from the energy output portion.
 5. The medicaltreatment apparatus according to claim 4, wherein the controller isconfigured to control the supplying portion which is configured tosupply the substance to the contact surfaces from the cutter as thecutter is moved.
 6. The medical treatment apparatus according to claim1, further comprising a fluid source configured to reserve the substanceto prevent the fluid from invading the body tissue, and configured tosupply the substance from the supplying portion.
 7. The medicaltreatment apparatus according to claim 1, wherein the energy outputportion is configured to output and apply at least one of ahigh-frequency wave, a microwave, a thermal-energy, laser light andultrasonic energy to the body tissues so that the body tissues areheated.
 8. The medical treatment apparatus according to claim 1,comprising a detector configured to detect information of the bodytissues held between the holding members, wherein the controller isconfigured to control the energy output portion to stop an output fromthe energy output portion in case that the information detected by thedetector has reached a predetermined threshold.
 9. The medical treatmentapparatus according to claim 8, wherein the predetermined threshold ofthe information indicates a state that the joined portion has formed.10. A control method of a medical treatment device to treat bodytissues, comprising: outputting energy from an energy output portion soas to join contact surfaces of the body tissues and form a joinedportion; judging that the joined portion has been formed; stoppingoutput of the energy from the energy output portion depending on resultof the judging that the joined portion has been formed; judging that theoutput of the energy from the energy output portion has stopped; andsupplying a substance, which prevents invasion of fluid, to the contactsurfaces of the joined portion depending on result of the judging thatthe output of the energy from the energy output portion has stopped. 11.The control method according to claim 10, further comprising moving acutter depending on the result of the judging so as to cut the joinedportion of the body tissues.